Manager, Technical Review (Claims Investigation)

Manager, Technical Review (Claims Investigation)

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As the Manager of Technical Review, the person must :

• Support the Head of Department in the development of the department to achieve the highest possible standard of excellence in all its activities.
• Assist in planning on operation and function of areas involving technical review and fraud for Claims and Underwriting.
• Monitoring the achievement of plans and updating the Head of Department on the results regularly.
• Functional bridge amongst providers as well as internal stakeholders.
• Coordinate and manage regulatory bodies, group and internal audit exercises for Fraud matters.
• Design investigation process and procedures both physically and digitally to identify potential fraud claims and advise management on multi-dimensional impacts.
• Lead the investigation process on potential fraud incidents and cases inclusive but not limited to field investigations / site visit on suspected fraud cases which includes obtaining, reviewing and securing of evidence of case for follow-up and mitigation measures.
• Review and research evidence / documents to analyze the overall trends and patterns of claims and synthesize data into a professional report with recommendations.
• Conduct Claims File Review for assigned type of claims and / or line of business.
• Prepare detailed working papers that evidence work performed, issues discovered and recommendations for improvement.
• Brief respective stakeholders on the review process including the workflow and the calibration process to support the File Review exercise.
• Collaborates with the respective stakeholders in the development of meaningful action plans that detail the tasks, resources and timeframes necessary to improve the claims process.
• Provide recommendation to the stakeholders to ensure the prompt and effective delivery of the action plans.
• Any other tasks deemed relevant and necessary by the Head of Department for the delivery of the Company’s targets.

Main Responsibility

Qualification and Experience Requirement

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