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