Claim Fraud Management Assistant Manager

About this role

Requirements;

• Min Bachelor Degree degree in any major

• Min 6 years working experience on Fraud Claim Management area and preferably with audit and investigation skills background.

• Experiences with Fraud Claim, Claim Audit and Claim Investigation Communication.

• Solid knowledge and strong competency of general insurance business and claim process.

• Certified Fraud Examiner (CFE) is a plus.

• Excel and Power BI

• Dana Analytic Skill, Audit and Investigation skills

• Implement and monitor company's strategy towards improving fraud saving.

• Identify potential frauds through regular CFR (Close File Review), OFR (Open File Review) and incidental reports/indications by team Claim or other parties.

• Assess the extent, materiality, and factuality of suspicious cases through on-site and/or off-site investigations.

• Propose recommendation for follow up on confirmed fraud cases to relevant departments.

• Produce Fraud Reports for both regional and internal purposes.

• Investigate any suspicious claims.

• Produce CFR & OFR Report with proposed/recommended corrective actions.

• Analyze monthly data set for potential fraud identification and recommendation for improvements.

• Set proper fraud alert rules for fraud detection and analysis purposes and continuously updating and monitoring the implementation of fraud rules to prevent fraud effectively.

• Improve fraud awareness among claim staffs through socializations and/or publications.

• Propose recommendation for follow up on confirmed fraud cases to relevant departments.

Originally posted on Himalayas