North West / North Wales: Greater Manchester.
£15,000 - £20,000
A new vacancy has arisen for a Claims Validator (Claims Fraud Operations) in Greater Manchester. The role will involve investigating and resolving caseload of suspected fraudulent claims (mostly comprising home theft cases) in order to achieve speedy and cost efficient conclusion and minimal financial loss to the company. There will be a claims cheque authority up to £250 and TIA claim handling authority of £25,000. To instruct investigators incurring costs up to £800 per claim. Incur database charges up to £20 per claim. To manage an ongoing caseload portfolio of up to 50 claims at any time comprising both motor theft and delegated personal injury claims. It is necessary to have a fraud prevention policy in place to ensure that the company have a robust process to detect and reduce fraud and to protect customers' interests in general through ensuring such costs are controlled and ultimately benefit all. Will conduct detailed telephone based interviews with claimants (predominantly involving motor theft) utilising Voice Risk Analysis technology. Conduct investigations into suspected fraudulent (non PI) home claims referred from the claims department. Conduct desktop investigations, including database searches and cognitive telephone interviews with customers, witnesses and third parties, to obtain evidence and progress the investigation. Liaising with other insurers, investigating Solicitors, and law enforcement agencies. Ensuring that case handling adheres to the terms of the Data Protection Act, Insurance Ombudsman recommendations, and all applicable regulatory requirements Will review whether home theft claims are indicative of fraud and refer findings to the Investigator for decision. Propose the investigation approaches to be undertaken, submitting proposal to Investigator including appropriate evidence gathering and information exchanges needed with external parties (insurers, solicitors, forensic engineers or law enforcement) for caseloads with reserves of up to £25k. Present evidence and make recommendations for claim repudiation based on investigation findings for approval by Claims Fraud Co-ordinator. Will compile supplier instruction, including appropriate content for approved external investigators for sign off by an Investigator. Must have the ability to assimilate information from multiple sources including automated detection tools, databases, interviews with claimants and other parties in order to quickly identify a suspected fraudulent case. Collation of evidence to an appropriate standard to ensure that decisions to repudiate a claim are correct and minimise the risks of customer complaints or action by the Financial Services Ombudsman. Able to manage a caseload with changing and conflicting priorities, whilst still delivering work of consistently high quality. Maintaining and developing relationships and effective negotiation with other teams and departments to ensure optimisation of fraud procedures, and to ensure open communication.
Must have proven claims handling experience in a personal lines environment. Working knowledge of the internet and insurance and financial services databases. Knowledge of cognitive/conversation management. Completion of National Open College Network certificate in Advanced Validation Solutions. Good communication, organisational and negotiation skills are important to this role. The jobholder will be self-motivated and able to work as part of team. An intermediate level of computer literacy is required.
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