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