FWA Program Business Lead

This is a business-led role requiring deep insurance and FWA domain expertise. Candidates with predominantly IT project management backgrounds without claims or fraud experience will not be considered.

We are seeking an experienced Claims FWA Program Manager to lead enterprise-wide fraud, waste, and abuse (FWA) initiatives within the insurance claims function. This is a business-facing leadership role requiring strong insurance domain expertise, analytics capability, and program management experience (not a typical IT PM profile).

The role focuses on protecting financial and reputational integrity by strengthening FWA detection, prevention, and governance frameworks across the organization.

Key Responsibilities

1. Strategic Leadership & Governance

Design and implement enterprise-wide FWA frameworks, policies, and operating models

Establish control testing procedures to proactively mitigate fraud risks

Drive alignment across Claims, Risk, Compliance, and Audit functions

Lead transformation initiatives to enhance FWA maturity across markets

2. FWA Advanced Analytics & Detection

Leverage advanced analytics, AI/ML, and data mining techniques to identify anomalies and suspicious patterns

Partner with data teams to develop predictive models and early warning systems

Translate analytical insights into actionable fraud prevention strategies

Continuously improve detection capabilities and reduce false positives

Demonstrated ability to deliver measurable outcomes such as fraud loss reduction, increased detection rates, and improved recovery performance

3. Program Management & Stakeholder Engagement

Lead end-to-end FWA programs, ensuring delivery against timelines, scope, and quality

Engage senior stakeholders across business units to drive adoption and execution

Present insights, risks, and recommendations to executive leadership

Influence decision-making through strong storytelling and data-driven insights

4. Reporting & Performance Management

Develop and deliver FWA dashboards, KPIs, and metrics

Report investigation outcomes, overpayment recoveries, and control effectiveness

Prepare materials for Audit Committees, Risk Committees, and Board-level reporting

Ensure regulatory and internal compliance requirements are met

Project Location*

Kuala Lumpur

Relevant Experience*

Minimum 10 years of FWA experiences in health insurance

A strong management consulting experiences to design, execute, validate and monitor the FWA risk mitigation framework and methodology

Strong exposure to program management in complex, cross-functional environments

Flexible to work with a team that is globally distributed.

Mandatory skills*

Minimum 10 years of FWA experiences in health insurance

A strong management consulting experiences to design, execute, validate and monitor the FWA risk mitigation framework and methodology

Strong analytics background (hands-on or strategic oversight of data science teams)

Exceptional interpersonal skills in areas such as teamwork, facilitation, and negotiations.

Experience preparing executive-level presentations and reports

Desired skills*

Familiarity with AI/ML fraud detection tools and platforms

Exposure to regulatory environments across APAC

Domain (Industry)*

Health Insurance

Total Experience (Ex. 5-7 Years)*

15+ years, with Minimum 10 years of FWA experiences in health insurance