Manager - Fraud Control Unit

KEY RESPONSIBILITIES

- Ensure that correct operating procedures are followed and adhered to deliver the case outcomes and monitor the quality of investigations carried out by the investigation agencies & verification officers

- Conducting field investigation of claims involving high value, HNI customers etc

- Co-ordinate with field investigators and help/guide them on claim investigations

- To actively participate in fraud detection activities such as: Data analysis, measuring fraud indicators, Process automations & IT enhancements, fraud audits etc.

- Fully support in the overall process of communicating any key messages to the business about fraud avoidance

- To comply with departmental SOP with respect to: fraud investigation, reporting and recovery

- Close liaison with the claims team, investigation agencies and other stakeholders in terms of fraud investigations and outcomes

- Liaise and share knowledge of fraudulent or suspected fraudulent providers and customers with counterparts at other health insurance companies and TPAs

- Participate in relevant training activity and regularly upgrade knowledge in the area of fraud risk

- Develop and implement system generated and manual fraud detection measures

- Other responsibilities as assigned related to fraud & risk control unit