Claim Fraud Management Assistant Manager

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