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Manager, Technical Review (Claims Investigation)
Generali MalaysiaKuala Lumpur, Kuala Lumpur, Malaysia2 hari lalu
Penerangan pekerjaanMeet Company’s Overall Targeted Technical Excellence Initiatives Lead and Monitor Technical Review Functions Ensure Investigation and Review Processes are in accordance with Agreed Processes with relevant Stakeholders Ensure All Fraud related matters are complied within the guidelines and regulation of BNM, PIAM, Group and other relevant regulatory bodies Possess a recognized degree in Insurance, Business Study, Legal or any other related subjects Preferably completion of professional insurance qualification (AMII / ACII) or equivalent Relevant working experience in general insurance field (underwriting, claims, etc.) At least 7 years of experience in claims function Exposure to multiple insurance businesses / models and across markets Some specializations in one or more areas in claims review Strong interpersonal and communication skills including the ability to interact with clients, upper management and law enforcement Honest and ethical with high levels of integrity and confidentiality Persistence to obtain case information not readily available with an eye for detail Ability to work independently with minimum supervision Good organizational skills needed to manage a high volume of assigned cases Proficient with the insurance procedures, regulations and investigation methods Hands on experience with relevant Information System Display good interviewing and interrogation skills along with the capability of drafting reports Result oriented, committed, team player, positive working attitude Ability to work with multicultural project teams and to foster a good work environment Ability to multi-task, plan effectively and meet deadlines Very good ability to strategize and drive execution Ability and interest to lead and develop junior team members
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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Technical Manager • Kuala Lumpur, Kuala Lumpur, Malaysia