MedNet Egypt is one of the leading managed care service organizations that caters to healthcare needs. We are looking for a skilled Assistant Manager – Investigation and Utilization Management who will be responsible for managing and leading the investigation and utilization management function to ensure early identification of cost drivers, abnormal billing patterns, and potential fraud, waste, and abuse (FWA) across all insurance policies.Your Job1. Leadership & Functional OversightManage, lead, and develop the Utilization Management team (Team Leaders and Senior Officers), ensuring workload prioritization, quality of analysis, and adherence to timelines.Set objectives, review performance, and provide coaching, technical guidance, and development plans for team members.2. Investigation & Utilization Management Lead investigations into suspected FWA, abnormal utilization, and irregular provider billing behaviors and track investigation outcomes, recoveries, and corrective actions to closure.Design and manage the investigation workflow – case intake, prioritization, evidence gathering, analytical validation, documentation, and closure.Build robust, well-documented investigation cases with clear analytical evidence, findings, and recommended actions suitable for internal review and regulatory reference.Determine escalation thresholds, validate findings, and formally refer high-risk cases to FWA Audit, Rule Engine, Approvals, Network, and QA teams as appropriate.2. Burning Cost, Loss Ratio & Utilization GovernanceOversee monitoring of burning cost and loss ratio across policies, products, and provider networks.Interpret utilization trends and patterns to identify systemic cost drivers, emerging utilization risks, and high-impact members, providers, clinicians, specialties, or benefit areas.Translate analytical insights into utilization control recommendations, corrective actions, and preventive measures.3. Billing Abnormalities & FWA OversightOversee identification of abnormal billing and utilization behaviors, including (but not limited to) overutilization, upcoding, unbundling, duplicate billing, excessive length of stay (LOS), repeated admissions, and unusual billing spikes.Act as the primary investigation and utilization subject-matter expert in FWA-related discussions.4. Analytics, Rules & Preventive ControlsLead development and refinement of utilization analytics models, business rules, flags, triggers, provider outlier detection methodologies, and focused sampling approaches.Support automation and rule engine initiatives aimed at early detection and prevention of cost leakage, ensuring outputs are actionable, consistent, and aligned with business objectives.5. Reporting, Governance & Decision SupportEstablish and monitor burning cost and loss ratio dashboards, provider utilization risk profiles, and utilization variance and trend reports.Prepare and present findings, risks, and recommendations to management with clear, actionable insights. and support internal and regulatory reporting related to investigation, utilization management, and FWA.6. Cross-Functional CoordinationAct as the primary coordination point between the Investigation & Utilization Management functions and Claims, Approvals, QA, Rule Engine, FWA / Medical Audit, Network, and Production teams.Your ProfileBachelor’s degree in Medical, Paramedical, Insurance, Healthcare Management, or a related field.Advanced certifications in utilization management, medical audit or analytics are an advantage.7+ years’ experience in utilization management, investigation, claims analytics, provider audit, provider network or medical audit within a health insurance / TPA environment.Minimum 3 years in managing cost containment or utilization management interventions/ initiatives.Proven experience in FWA detection, investigation case management, and payment integrity.Awareness of local regulatory requirements and the UAE market is preferred.Advanced analytical, investigative and decision-making skills.Advanced Excel and data analysis capability (working with large datasets).