Investigador FAWE

Responsibilities

• Investigate and analyze cases suspected of fraud, abuse, waste, or error (FAWE) using technical, legal, and regulatory criteria.
• Ensure correct documentation of investigations by integrating information chronologically and ensuring traceability.
• Support decision-making by validating consistency between medical, administrative, and financial information.
• Perform detailed technical analysis of documentary, medical, and operational information to identify atypical patterns.
• Propose corrective or preventive actions based on identified deviations in processes or controls.
• Maintain compliance with data protection regulations and internal guidelines.

Requirements

• Bachelor's degree in Administration, Law, Criminology, or a related field.
• Valid professional license (cédula profesional) is required.
• 1 to 2 years of experience in the insurance sector or administrative roles, preferably in fraud investigation.
• Proven knowledge in fraud prevention, detection, and investigation within the insurance or financial sectors.
• Experience using fraud monitoring systems and generating finding reports.
• Intermediate English level (ability to translate to Spanish).

Preferred Qualifications

• Specialization in Health Services Administration or Insurance Administration.
• Certifications in Anti-Money Laundering (AML) and Counter-Terrorist Financing.
• Certifications in fraud and abuse prevention within the insurance or financial sector.

About the Company

SEGUROS MONTERREY NEW YORK LIFE is a leading insurance provider dedicated to protecting the well-being and future of its clients through specialized financial and insurance solutions.