Claims Investigations Manager

1 week ago

North Lakes, Queensland, Australia Auto & General Insurance Full time

About us


At Auto & General (A&G), we provide smarter products and solutions to safeguard our customers in their time of need.

Our range of general insurance products protect customers on the road, at home and on holiday with various Car, Motorcycle, Home, Contents, Pet and Travel Insurance products as well as Roadside Assistance.


The role
This role manages the Investigations teams within Claims and Assessing.

The team is responsible for all aspects of investigation, management, analysis, and prevention of fraud; with an overriding focus on optimizing the performance of the fraud & investigations team.


This team additionally analyses portfolio trends and savings/ risk opportunities whilst raising fraud awareness within Claims & Assessing - ultimately reducing the fraud risk to Auto & General.


  • Lead and develop a team of experts to personally investigate, complex suspicious claims or suspicious insurance related activities covering all areas of the Claims & Assessing business
  • Clear focus on customer service and service effectiveness to deliver a strong KPI performance.
  • Leading this team of investigators and investigative support to conduct complex investigations into allegations of fraud activity against Auto & General.
  • Build strong investigation concepts (evidence preservation and collection, data privacy, legal privilege, investigative interviewing technique, business intelligence)
  • Coordinate senior briefings and reporting across the law enforcements community to harness expertise and leverage opportunities for Auto & General.
  • Personally, manage all aspects of the claims investigation relating to complex suspicious claims including providing reports and guidance to other instructed experts such as building assessors and loss adjusters.
  • Mentor investigators within the teams, including leading capability and training programs, professional development and performance management programs where required.
  • Ensure that all fraud referral/ nondisclosure decisions and processes/ handoffs are appropriately targeted with mínimal false positives (hence the lowest possible impact on customer experience)
  • Develop an open file review methodology for Claims & Assessing to review the effectiveness of Fraud awareness and Investigation methodologies
  • Ensure that all staff development relating to advanced interview and behavioural fraud investigation training for both the Fraud Team and appropriate staff across Claims & Assessing is optimised
  • Lead referral/ technical support on potentially Fraudulent claims across both Claims & Assessing and IDR prior to and post submission to FOS
  • Develop targeted Closed File Review Programmes, with a focus on Fraud to ensure that suggestions for improvement are closely aligned to correctly scoped/ detailed process/ system changes and training/ development plans
  • Develop a clear understanding of Industry trends and opportunities both in terms of fraudulent/ criminal activity and technological advances to ensure that Auto & General remain aware of and engaged in early business opportunities
  • Maintain sound knowledge of Regulatory requirements, company processes, systems, products, and brands.
  • Lead the development and delivery of the investigation program's governance, policy, and guidelines frameworks.
  • Represent Auto & General on Industry Forums/ Bodies.
  • Manage the supplier relationship with our panel of external investigations firms. This role can be based out of our North Lakes or Kawana office with some crosssite travel expected

What experience you'll bring

  • Relevant Tertiary Qualifications in Fraud or investigation
  • Demonstrated regulatory investigations experience, with the ability to coordinate and lead investigative programs.
  • Experience delivering outcomes within a strict regulatory governance environment, including the ability to lead and coordinate a compliance control reporting framework and work collaboratively with regulatory stakeholders.
  • Strong capability in building stakeholder relationships to harness opportunities and deliver Fraud awareness & educations strategies.
  • Demonstrated ability to drive high quality investigative outcomes; effectively prioritizing and progressing a Fraud control framework.
  • Ability to think strategically, identify potential risks to stakeholders and build capabilities using data, analytics, system information sharing and innovative tools.
  • A thorough knowledge of evidence collection and expertise in pursuing lines of enquiry within the Insurance Industry
  • Strong ability to manage/ influence key stakeholders, including external Claims' suppliers
  • Understanding of the Insurance Contracts Act, Criminal Law, disclosure, nondisclosure, and materiality
  • Demonstrable experience in managing sensitive customer and business partner relationships
  • Strong verbal and written communication skills
  • An ability to develop systemic procedures and analyse data/ trends, acting appropriately
  • Strong lead

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