Description

A dedicated handler for all suspicious claims referrals within your specialism in your Claims Handling Centre. To explore, investigate or negotiate those claims as appropriate, and without any significant impact on customer service. Make reasonable judgements on the point at which claims identified as potentially fraudulent should be referred into the Claims Validation Team for ultimate pursuance of a fraud saving. Constantly strive to improve local fraud awareness as means to reach the Fraud identification target for your specialism. Take overall responsibility for the correct usage and inputting of information on to the Claims Risk Indicator systems. Maintain own spreadsheets around Risk Indicator and referral activity. Work closely with the Businesses` chosen counter fraud agents, the Head Office Fraud Team, Claims Validation Team, and the Claims Handling Teams.

Main Duties

Undertake appropriate investigations on all new suspicious claim referrals, within agreed turnaround times, adding those cases that remain suspicious on to the Claims Risk Indicator system prior to referring to Claims Validation Team, or returning to the Claims Handling Teams in the event that your investigations satisfy the original concerns.

Conduct Team meetings and bespoke training sessions to the Claims Handling staff to promote fraud awareness as a means to ultimately achieve your specialisms KPT around fraud identification.

Ensure full and proper usage of the Risk Indicator system for your specialism by conducting regular audits.

Devise and maintain own MI spreadsheets based around `types¿ of fraud referral, the outcome of the referral, and any other activity relevant to your specialism that could reasonably be used as a basis to recommend future fraud deterrent solutions.

Act as point of liaison between the Head Office Fraud Team, Claims Validation Team and Claims Handlers. In the case of Head Office, that will extend to include accurate returns on cases highlighted as suspicious by the tool available.

Fostering good working relationships with the Businesses¿ chosen counter fraud agents

Technical Skills

Ensures up to date knowledge and
understanding of all relevant Compliance and Regulatory rules and processes.
Proficient in the use of mainframe computer and has keyboard proficiency and speed.

Displays effective navigation to allow
application inputting, storing and retrieving of data as required.
Able to follow procedures and complete
documentation accurately.
Ensures up to date knowledge and
understanding of best practice.
Recognises circumstances requiring further investigation eg potential fraud, non disclosure, ex-gratia etc; controls investigation (under referral) that is appropriate to the circumstances.
Understands and complies with litigation and pre-litigation protocols and procedures.
Recognises policy details and interprets cover accurately.
Able to assess the requirement for and provide instruction to appropriate experts.
Complies with the Claims Complaint
Resolution procedure in the handling of
customer complaints

Experience

Experience of Customer Service and Claims experience within the speaiclism for which you are applying is essential as is Claims Fraud and/or validation experience.

Qualifications

GCSE English and Maths or equivalent. Progress towards CII or any legal qualifications an advantage.

Personal Attributes

Good organisational skills.
Excellent communication skills.
Ability to prioritise own workloads. Customer focused.
Self motivated.
Positive and enthusiastic

Office Address

Claims Centre, PO Box 952, Woking, GU21 6XQ