Regular review of open files in order to identify root causes of claims leakage and the translation of those findings into action plans to reduce leakage through process improvements and/or training.
To manage the specialised claims from point of notification up to settlement i.e.manage the progress of Adjusters investigation
Periodic monitoring outstanding claim files with Adjusters.
Review work processes and provide solutions in improvement of claim guidelines and work processes.
To assist in department's administrative works, systems and procedures for smooth operations and continuous improvement.
Performs investigation of potential fraud cases to uncover the fraud pattern and also the parties involved.
Developing claim reviews plans (including outstanding and closed cases).
Review, investigate and actively involved in all complex and contentious claims referred to the team to ensure compliance with policy requirements and smooth settlement.
Analyses and maintains an up-to-date knowledge and data of fraud trends in the market.
Backup team members and assume the responsibilities as and when required.
Perform other duties as delegates by the Management.
Ensure compliance to policies, guidelines and regulations
Key Requirements
Bachelors Degree or equivalent, in any related field / Associated MII / CII.
Minimum 5 years experience in P&C claim handling.
Well verse with claims processes and handling.
Good policy understanding in terms of the policy conditions, exclusions etc.
Good judgement and able to make decision.
Good communication skills
Familiar with the use of AI tools such as ChatGPT for tasks simplification
