Senior Fraud Analyst

Job description

The Fraud Analyst role plays a key part in our global claims cost containment strategy. The ideal candidate will have an inquisitive mind and be focused on ensuring we prevent fraudulent activity/ waste and abuse at all stages of the claim journey.

The role requires the ability to multitask across numerous disciplines within the global claims department and is ideally suited to a strong self-starter with excellent time management skills and a desire to develop within the organization

Key responsibilities/What you do:

• Identify & investigate fraudulent activities on ADNIC Health Claims and present fraud reports to the relevant stakeholders
• Participate in the role of Auditing & FWA Reporting of ADNIC Health Claims in line with Operations Auditing Practices, and regulatory requirements.
• Review and assess other areas of fraud, waste & abuse risk across ADNIC portfolio to identify potential fraud or misrepresentation.
• Identify & report cost containment opportunities.
• Provide input into Operations Controls to achieve acceptable cost containment & fraud identification standards.
• Create & Facilitate Anti-Fraud Awareness & support material as required
• Liaise with Global Operations Functions to ensure consistency in the application of the Global Claims Fraud Framework across ADNIC Health Claims
• Respond to client enquiries accurately and professionally and when necessary, liaise with additional departments to ensure an efficient response is given thereby achieving client satisfaction.
• Other Ad Hoc tasks or projects in order to support the team and other areas of the business

AI READINESS Work effectively in an environment shaped by artificial intelligence (AI), machine learning, data analytics and cloud-based tools, using insights responsibly with our standards of data governance, security and ethical use

Key requirements/What you bring:

• Bachelor’s degree in any Medical field, Finance, Business Administration, Insurance, or a related field preferred.
• Minimum 2 years’ experience in a customer focused environment, ideally in clinical, paramedical roles or TPA or health insurance roles.
• Experience in problem solving & decision making
• Excellent level of written and verbal English is essential.
• Comfortable with problem solving & decision making
• Experience in analyzing and assessing medical claims of high values and complexities
• Ability to communicate effectively with various audiences and all levels of the organization
• Proficiency in MS Office (in particular in Excel, Power BI, PowerPoint)
• Legally permitted to work in the country of operations.
• Hybrid working option available as per business requirements.2nd Language preferable

How we hire Allianz Partners does not accept unsolicited CV’s or approaches from agencies. We only work with partners on our approved supplier list, under contract. Any unsolicited submission will not be considered.