Senior Expert, Claims Fraud Management

il y a 1 mois

SaintOuensurSeine, France Allianz Partners S.A.S. Niederlassung De Temps plein

What you do


Reporting to the Head of Fraud Management ‘Senior Expert- Claims Fraud Management’ position is placed in the Central Team within our Operations Steering and Transformation division. The role is focused on extending the claims management expertise to virtually all domains- the policy (Functional Rules) documents and the SOPs, training of claims and the fraud management teams on claims frauds, cross-LoB (line of business) fraud management process overall, integration of the fraud management process in the overall claims management process in Operations, enabling technology to augment fraud detection through incisive busness rules around claims frauds.

Create/Drive a sustainable framework for Claims Frauds Management

Work with Claims Management Operations team to ensure the integration of the fraud management process in the overall claims management life cycle- to ensure necessary proactive fraud management intervention to prevent frauds at all possible stages Review the existing cross-LoB process of fraud referrals (from claim handlers) and the positioning of the technology solution in the overall claim management life cycle and suggest the best options.

Lead the documentation around governance

Create / Review and publish to stakeholders the Fraud Management Functional Rules annually aligning the same to the trends prevailing in the industry and to the Group standards and guidelines Ensure strict compliance to Group policies and guidelines in the AzP documents on fraud management Create / Review the claims fraud referral process globally and ensure consistent application across BUs Create / Review the cross-LoB Standard Operating Procedures (SOPs) globally across SOPs, ensure consistency and the alignment to the local country specific trends.

Training and Upskilling teams

Create / Revise the standard training material for the training of the new joiners at the on-boarding stage and allow room for customization to the local business mix in the BU Create / Revise the standard training material for the training (including the refreshers) of the Claims team (essentially the Claim Handlers). Ensure consistency across BUs and keep flexibility to accommodate adjustments based on the local business needs in the BU Create a cross-LoB training material for the training of fraud management teams Create a process to track centrally the trainings completion by the participants.

Operational Excellence

Change Management: Leverage the deep knowledge around claims management and claims frauds, review existing claims fraud management processes to support AzP to implement change, adopt best practices and the continuous improvement Conduct training workshops with BUs to share best practices in triage and fraud investigation processes and look for continuous improvement in the process Evaluate the creation of a certification process for fraud management teams and the claim handlers Be the custodian of the shared fraud prevention portal and ensure the relevant updates (for example, the best practices, the case studies etc.) intended to coach and guide the fraud detection and the investigation teams at the Business Units.

Inputs to technology tools on fraud triggers

Work with the central data analytics team and the Projects team to exchange insights around claim frauds in BUs- extend value added support to devise and appropriate fraud management strategy- help optimize the business rules / red flags based on the prevailing fraud trends, to augment fraud detection Support evaluating alternative detection tools leveraging the existing technology framework in the company (especially for Travel line of business in non-ACM BUs and for other LoBs (lines of business) who may not have a technology solution for fraud detection.

Contribute to effective KPIs to monitor performance

Provide support to institute incisive KPIs to measure the performance of Claims Frauds Support the Data Analytics and the Projects Team in automating the generation of reports and dashboards leveraging the existing technology framework in the company.

External focus and the visibility

Keep connected to the industry, the trends, the detection solutions available - helps learn the best practice externally Have an operating rhythm to share the insights learnt externally with the teams globally Provide support to institute incisive KPIs to measure the performance of Claims Frauds.

Key responsibilities

Extensive experience in Fraud and Leakage Management in the Financial Services/ Insurance space Strong experience in insurance claims frauds management and also the claims leakage control in the past Knowledge of the legal principles giving rise to subrogation and being able to develop methods to ensure successful recovery Experienced in identifying and analyzing fraud trends financial trends and manage claims in line with expected loss ratios and management criteria General understanding of Legal issues & Regulatory requirements related to Claims Frauds Excellent communication skills(English-oral and written both) Strong analytical abilities- should be able to decipher fraud/leakage trends basis the data presented Highly motivated, dynamic, self-steering Previous experience in international settings and cultural sensitivity (experienced of having worked for several geographies) Strong interpersonal skills, able to foster relationships with peers and other functions.

Key requirements/What you bring

Minimum of 15 years of experience in Fraud and Leakage Management in the Financial Services/ Insurance space Strong experience in insurance claims frauds management and also the claims leakage control in the past; exposure to Insurance Claims environment is a must Knowledge of the legal principles and to be able to develop methods to ensure successful recovery, wherever possible, and experienced in identifying and analysing fraud trends financial trends and manage claims in line with expected loss ratios and management criteria and a general understanding of Legal issues & Regulatory requirements related to Claims Frauds Solid IT system skills (understanding of how a fraud detection tool works in the insurance space), competent MS-Office skills, excellent communication skills (English, oral and written), strong analytical abilities (should be able to decipher fraud/leakage trends basis the data presented) Previous experience in international settings and cultural sensitivity (experienced of having worked for several geographies)

Key benefits/What we offer

More information regarding the Allianz Partners lines of business can be found at .

Allianz Group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams and challenges, is what makes us a unique employer. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow and to shape a better future for our customers and the world around us. 
We at Allianz believe in a diverse and inclusive workforce and are proud to be an equal opportunity employer. We encourage you to bring your whole self to work, no matter where you are from, what you look like, who you love or what you believe in.
We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, disability or sexual orientation.
Join us. Let's care for tomorrow.

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