Manager Claims Audit & Investigation
The purpose of this role is to assist in the development then management of the Claims Audit and Investigation process in accordance with the approved guidelines and approach.
Claims Audit and Investigation:
- Review and understand ARPC’s claims policies and processes.
- Initially work with the Executive Manager Claims (and other resources as required) to build ARPC’s Audit and Investigations guidelines and approach, then look for continuous improvement once implemented.
- Direct cedant engagements to undertake an efficient and effective audit and investigation of claims paid in accordance with approved guidelines and approach.
- Supervise the resources required to complete reviews as planned. This may involve actively undertaking the reviews as required.
- Liaise with cedants to complete the reviews, managing the review engagement end to end, including the reporting of any findings or issues raised as part of the cedant claims review.
- Maintain data integrity within ARPC’s claims management system.
- Raise questions escalate issues with the EMCAA where ambiguities or unusual situations arise.
- Ensure that all claims related matters are dealt within the timeframes set out in the Legislation and Reinsurance Agreements.
- Identify suspicious or potentially fraudulent claims and notify the EMCAA.
- Arrange investigation and liaise with legal counsel if further action needs to be taken.
- Provide reports, both internal and external, as required regarding reviews undertaken and key activity.
- Assist in the understanding of claims issues and risks, recommend and implement changes based on identified inefficiencies.
- Review data and undertake analysis of claims paid as required for internal and external stakeholders.
Contact: [email protected]