Job Purpose:

To support the Fraud Management Unit by conducting fraud investigations, analysing data, and providing actionable intelligence to detect, prevent, and mitigate fraud in major claims.

The role ensures compliance, operational efficiency, and contributes to safeguarding the organisation’s financial integrity while maintaining a positive customer experience. The role also drives MIS reporting excellence, meaningful analytics and process improvement initiatives that can be leveraged to optimise operational efficiency, risk management and strategic decision-makings across operations.

Key Responsibilities:

• Review major claims for fraud indicators, conduct investigations, and gather evidence for resolution including engaging key stakeholders to manage red flag and termination dialogue.
• Use analytics tools to identify patterns, anomalies, and emerging fraud risks.
• Design and maintain dashboards, generate accurate and insightful reports on fraud, trends, case outcomes, and KPIs for leadership.
• Identify inefficiencies in fraud and claims processes; propose and implement solutions leveraging Lean Six Sigma and automation.
• Ensure all investigations adhere to regulatory and internal standards.
• Partner with cross-functional teams to implement fraud prevention measures and share insights.
• Recommend process enhancements and leverage technology for efficiency.
• Explore technology, AI and automation opportunities to enhance fraud detection and reporting capabilities.
• Monitor emerging fraud trends within the insurance industry and update internal controls accordingly.

Qualifications:

• Degree in data science, engineering, business administration or equivalent combination of education and experience
• Data Analyst Professional certificates preferred. Power BI, Tableau Desktop Specialist, Lean Six Sigma or equivalent certification

• Minimum 5 years data analytics experiences