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Anti-Fraud & Claims Excellence Manager

Anti-Fraud & Claims Excellence Manager

Europ Assistance East AsiaPetaling Jaya, Selangor, Malaysia
1 hari lalu
Penerangan pekerjaan

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Drive the transformation of Claims / Cases operations across East Asia on all business lines by embedding technical excellence, advanced analytics, and strategic fraud and cost management capabilities.

This role will define and execute the Claims Excellence Program, integrating data-driven insights and group-aligned frameworks to elevate performance, reduce leakage, and enhance fraud detection. The manager will work closely with Group experts to build East Asia competencies and ensure alignment with global standards.

Anti-Fraud & Costs Management Framework Development

  • Define and deploy the Claims Excellence strategy across East Asia platforms, aligned with Group guidelines.
  • Collaborate with Group experts to develop a regional competency framework for fraud and cost management.
  • Act as Global Process Owner for Claims Excellence controls within transformation programs (e.g., auto-adjudication, iCompass).
  • Reinforce and supervise the anti-fraud program, ensuring continuous improvement of tools and processes.
  • Monitor fraud KPIs and ensure achievement of fraud reduction targets on all aspects of the value chain (end-customers, agents, providers).
  • Manage fraud referents and support high-stakes fraud investigations.
  • Apply statistical and anomaly detection techniques to identify irregularities in claims data.

Cost Management & Recovery Optimization

  • Detect and implement recovery / cost avoidance opportunities, monitor KPIs, and report outcomes.
  • Supervise CFR campaigns, ensuring data quality and adherence to Group Claims FbF Policy.
  • Collaborate with underwriting teams to address unclear T&Cs and reduce leakage.

    • Data Science & Technical Analysis

  • Leverage big data tools (Python, Jupyter, etc.) to perform advanced statistical analysis and modeling.
  • Develop predictive models and dashboards to support decision-making and performance monitoring.
  • Fine-tune auto-adjudication and fast-track modules using data insights to improve technical performance.

    • Claims Quality & Medical Collaboration

  • Oversee claims quality control, ex-gratia payments, and medical referral initiatives.
  • Collaborate with medical teams to assess preexisting conditions, secure coverage checks and mitigate fraud and costs.

    • Stakeholder Engagement & Change Enablement

  • Represent Claims Excellence in key initiatives, including IT tool development and transformation programs.
  • Engage with cross-functional teams and senior leadership to drive adoption and continuous improvement.

    • Requirements

  • 5–10 years of experience in insurance claims management, preferably in motor, home, travel, or health assistance.
  • Strong analytical and data science skills, including proficiency in Python, Jupyter, and statistical modeling.
  • Proven experience in fraud analytics, cost optimization, and technical claims oversight.
  • Excellent communication, stakeholder management, and leadership capabilities.
  • Ability to manage multiple priorities under pressure and deliver measurable business results.

    • #J-18808-Ljbffr

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