Insurance Fraud Investigator / Senior Claims Officer

Job Summary

• As Senior Claims Officer, you will serve as the Insurance Fraud Investigator responsible for the daily activities of the Claims Counter-Fraud Team in order to prevent, detect and investigate suspected external fraud against the organization and its customers, to ensure that all claims fraud risks are effectively and efficiently governed and managed

Job Accountabilities

• Provide first class and effective Claims Counter-fraud services to Claims function, by identifying fraudulent claims, delivering high quality and professional investigation reports with decisive conclusions and technically excellent content
• Provide operational and technical management of the teams and work alongside the Head of Claims Excellence to develop strategy and maximize savings in areas of responsibility
• Monitor and steer highly complex cases (assigned or escalated to you) 
• Handle technical referrals, complaints and work closely with internal audit on Claims Fraud performance
• Conduct quality review of closed fraud cases performed by the team, as well as occasional reviews of open files depending on need
• Identify, investigate and document/report fraudulent claims
• Serve as day-to-day contact with Claims managers to ensure effective execution of fraud strategies
• Adhere to local regulation and Zurich Claims governance requirements throughout the investigative process to ensure that all information and data is obtained within data protection rules and regulations
• Collate and analyze accurate fraud data to provide information and Management Information for internal communications in order to support ongoing promotion of, and adherence to the claims fraud strategy

Job Qualifications

• Bachelor degree or equivalent
• Insurance qualification is preferred
• 4 years relevant experience in insurance claims investigation; professional investigative experience with an external agency is required
• Knowledge of insurance fraud; claims investigation experience in Employees’ Compensation, Liability and Motor Third Party Liability preferred
• Field investigation skills including interviewing and statement taking etc.
• A logical, methodical and systematic approach to work
• Recognize the benefit of providing excellent customer service
• Able to manage cases proactively to achieve best outcome
• Desire to learn and be flexible to business change
• Able to describe common benchmarks to measure performance
• Negotiation skills
• Good communication and interpersonal skills
• Knowledge of PC software
• Common sense
• Understand legal and contractual framework
• Able to monitor service providers’ performance and ensure the use of them in an effective manner
• Candidates with different levels of experience will be considered for other positions

Why Zurich

At Zurich, we like to think outside the box and challenge the status quo. We take an optimistic approach by focusing on the positives and constantly asking What can go right? 

We are an equal opportunity employer who knows that each employee is unique - that’s what makes our team so great! 
Join us as we constantly explore new ways to protect our customers and the planet.
 

• Location(s):  HK - Hong Kong