Fraud, Waste & Abuse (FWA) Coordinator

Provide operational and administrative support that enables FWA leadership, investigators and analysts focus on fraud investigations, case management and regulatory compliance. The ideal candidate is polished, highly organized, self-directed, and thrives in a demanding environment with multiple competing priorities. The candidate must possess excellent judgment, exceptional attention to detail, strong interpersonal skills, with the ability to manage highly sensitive and confidential case files.  
 

Key Responsibilities:

Case Intake & Tracking

+ Work CMS-HPMS and AHC A -MPI memos

+ Monitor FWA inbox and referrals

+ Log FWA referrals and assess before an investigation is opened

+ Ensure case files in tracking system (Inovaare) are complete and audit-ready

+ Track reporting logs

Provider & Member Correspondence

+ Coordinate requests for medical records and supporting documentation