Team Member Fraud, Insurance procurement & Claims File review

To promote the involvement of all stakeholders in all phases of the campaign – planning, execution, results analysis, identification of improvements areas and follow up of action plan.

Academic/Professional: BSc/Degree from a reputable Tertiary Institution in Management, Accounting, Social Sciences or other business-related disciplines, Professional qualification (i.e. ACA or ACCA, AIIN, PM or others of similar equivalence).Possession of an MBA is an advantage.

Work experience:  2 – 4 years professional experience in related position.

Job Level: This position has been profiled as a minimum Analyst role owing to the defined skill level, years of experience and complexities of the task to be performed.

Grade Level: This position has been profiled as a minimum Analyst 8 owing to the defined skill level, years of experience and complexities of the task to be performed.

Key Responsibilities

• Develop CFR Matrix or obtain an existing matrix from the region and customize to suit our entity’s reality.
• Calculate campaign sample size.
• Prepare all documentation needed to run Campaigns.
• Analyse and communicate campaign results to the relevant stakeholders.
• Organize and lead focus group sessions with claims teams to identify improvements to claims process capable of mitigating identified/detected leakage causes.
• Set up triggers that are indications of fraud or attempted fraud within the claims process flow.
• Carry out investigations that may be required from time to time.
• Carry out periodic spot checks to evaluate the implementation of corrective actions and submit timely reports.
• Carry out quarterly Quality Assurance reviews on claims paid within the preceding quarter and present results for review and implementation.
• Follow-up on improvements action plans and communicate progress to all key stakeholders within AXA Mansard Group and/or the Region.
• Be responsible for forecasting leakage evolution.
• Provides necessary assistance to implement and support for Quality Improvement projects
• Any other responsibilities that might be required by the Business, Unit Head / Head of Technical from time to time.
• Claims management (P&C, L&S, and Health Lines of Business)
• Knowledge of Insurance Industry & good knowledge of AXA mansard Group and its businesses.
• Investigative skills
• Team spirit and collaborative