Job Scope / Position Summary As the Head of Technical Review, the person must: Develop the unit to ensure it achieves the highest possible standard of excellence in all its activities. Planning on operation and function of areas involving technical review and fraud for Claims. Organizing production of work and workforce i.e. productivity, allocation of resources. Monitoring on achievement of plans. People development for succession planning and personal career growth and provide guidance, direction, leadership and support to unit members. Plan methods and initiatives to improve the efficiency and effectiveness of the Claims Technical Review operations. Functional bridge amongst providers as well as internal stakeholders. Coordinate and manage regulatory bodies, group and internal audit exercises for Claims 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 Review on Closed Files 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 claims managers on the review process including the workflow and the calibration process to support the Review exercise. Collaborates with the claims management team in the development of meaningful action plans that detail the tasks, resources and timeframes necessary to improve the claims process. Provide recommendation to the claims teams to ensure the prompt and effective delivery of the action plans. Main Responsibility (example but not limited to) 1. Meet Company's Overall Targeted Claims Fraud Figures Fraud Detection Rate Fraud Savings 2. Design, Introduce and Monitor Claims Technical Review function Identify high risk sector of claims Recommend actions of improvement Produce quarterly monitoring reports 3. Ensure Smooth Investigation and Review Process with SOP being followed Customer expectation management for investigation files Engaging with external providers for investigation files Manage system related matter (Frontend and Backend system) 4. Ensure All Fraud Claims related matters such as communications, system set-ups, processes, reporting etc. are complied within the guidelines and regulation of BNM, PIAM, Group and other relevant regulatory bodies. Qualification and Experience Requirement 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 8-10 years of experience in technical claims review Exposure to multiple insurance businesses/models and across markets Some specializations in one or more areas in claims review Experience in leading fraud unit/technical review team 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 Show more Show less