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Manager Claims Fraud Prevention

Manager Claims Fraud Prevention

Level: EL1

The purpose of this role is to manage ARPC’s claims prevention program of work for both the terrorism and cyclone pool’s, including of claims leakage/fraud prevention, detection, recovery, and alignment with industry best practice.

Development / Overseeing Reinsurance Claims Leakage and Fraud

  • Detection and Prevention: Develop, implement, and continuously enhance claims leakage and fraud detection strategies and initiatives to mitigate fraudulent claims. Collaborate with cross functional teams to strengthen anti-fraud measures.
  • Investigation and Analysis: Conduct in -depth analysis of claims data and patterns, as well as internal benchmarking of insurers, to identify high risk claims and potential fraud. Lead the investigation of suspicious claims, using advanced tools and techniques where required.
  • Recovery: For identified frauds liaise with appropriate parties to take action on recovery.
  • Policy Development: Contribution toward the development of a framework to identify and assess fraud risks, as well as policies and procedures related to fraud detection reporting and prevention. Ensure compliance with industry regulations and standards.
  • Collaboration: Collaborate with claims and underwriting teams as well as other departments to share information and improve claims leakage and fraud prevention efforts. Partnership with the Commonwealth Fraud Prevention Centre for a whole of government approach to fraud detection and management working together on fraud countermeasures and reporting.
  • Quality Assurance: Ensure the quality and accuracy of claims audit and fraud investigations, maintaining a high standard of work while adhering to deadlines.

Advisory to ARPC teams for both Cyclone and Terrorism Reinsurance

  • Support HOTC where required
  • Assist the HOTC to provide guidance and comprehensive technical information to the stakeholders in relation to reinsurance offered by ARPC.
  • Understand claims data to develop insights for stakeholders and understanding insurer performance

Other

  • Support and provide back-up in time where there are volume surge/resource constraints for claims payment and audit
  • Participate in ARPC Corporate projects as and when opportunities arise.
  • Champion risk culture values and a strong advocate for good customer outcomes
  • Promote continuous improvement to ARPC’s products and services having regard to product assessments, IT solution and business efficiencies.
  • Identify, communicate, and solve issues within ARPC that arise in the administration of the TCI Act
  • Role model ARPC’s Values and Code of Conduct and Capabilities set out in the ARPC’s Capability Framework.

The closing date for applications is Monday 20 January 2025.

Contact: [email protected]

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Insurer customer logins to ARPC

Terrorism Insurer Portal (PACE)

PACE is ARPC’s new Terrorism Reinsurance Pool (terrorism pool) insurer customer portal, which allows terrorism pool insurer customers to lodge their company information in a secure and user-friendly environment.

Cyclone Insurer Portal (PACE)

PACE is ARPC’s Cyclone Reinsurance Pool (cyclone pool) insurer customer portal, which allows cyclone pool insurer customers to lodge their company information in a secure and user-friendly environment.