Claims Fraud Manager - Suit ex Gardai

Job Description

The Claims Fraud Manager will develop a specific and focussed fraud plan to include investigation of fraud, fraud templates, red flags, internet fraud etc. He/She may also conduct investigations to detect fraud on claims against the company together with providing investigative expertise to limit exposure and protect company assets. These investigations involve all lines of insurance and this position may in future include lead investigator functions as described below.

Roles/Responsibilities

• Conduct investigations with a focus on thoroughness, attention to detail, timeliness and cost control.
  
• Prepare and submit reports covering all phases of the investigation in each case for approval.
  
• Assist with the development and training of the claims staff in the detection of external/internal fraud.
  
• Interpret and convey highly technical information to others in a clear, concise manner.
  
• Apply rules of evidence; recognize evidence and determine it's value to specific claims, evidence collection and interpretation.
  
• Establish and maintain liason with An Garda Siochana and others to obtain assistance with conduction of investigations.
  
• Develop a network of resources within the community - IIF Fraud Committee, An Garda Siochana, insurance associations, professional associations and community groups.
  
• Supply timely and accurate Management Information to the Head of Claims on agreed KPI's.

Skills/Experience

Minimum 10+ years law enforcement or 10+ years broad claims experience, of which at least 2 years focussed on insurance claims fraud investigation.

Working knowledge of insurance and claims operations for both personal and commercial lines insurance.

Possess a clear understanding of the rules of evidence and a sound knowledge of the fraud statutes, including the Civil Liability & Courts Act 2004 & the Criminal Justice (Theft & Fraud Offence) Act 2001.

High degree of integrity and confidentiality required handling information that is considered personal and confidential.

Awareness of the Data Protection Act 2003 and specifically the Code of Practice on Data Protection for the Insurance sector.

Highly developed interviewing skills with proven investigation interviewing techniques.

Personal Attributes

Highly analytical, a logical & sequential thinker, computer literate.

Well developed Conflict Management skills.

Strong business acumen and understanding of the Insurance business financials and operational metrics.