Fraud Management Specialist

Job Title: Fraud Management Specialist

The Fraud Management Specialist plays a pivotal role in protecting the organization from fraudulent activities across various business lines. This position reports directly to the Investigations Team Lead and is responsible for overseeing investigations and fraud cases on a daily basis, focusing on the Travel Claims and Medical Services portfolio for Australia & New Zealand.

This role serves as the driving force behind managing fraud and building a culture of awareness and vigilance within the organization.

Key Responsibilities:

• Develop and implement a robust zero-tolerance fraud policy across the business
  
• Design and execute fraud prevention and detection strategies aligned with global industry standards
  
• Identify and implement process improvements to enhance fraud detection and recovery outcomes
  
• Ensure consistent interpretation and application of Fraud Management Functional Rules
  

Fraud Investigation and Management:

• Manage fraud cases effectively to minimize claim leakage and fraudulent payouts
  
• Coordinate investigations and ensure timely closure of fraud files
  
• Contribute to the development of a comprehensive fraud management framework and culture
  
• Collaborate with legal teams and law enforcement agencies on high-value or sensitive fraud cases
  

Operational Excellence:

• Ensure timely triage and investigation of fraud alerts from multiple sources
  
• Maintain and enforce Standard Operating Procedures (SOPs) for fraud referrals and investigations
  
• Monitor and report on key performance indicators such as fraud referral rate, proven fraud rate, and investigation turnaround time
  
• Utilize data analytics to identify fraud patterns and optimize detection rules
  

Training and Awareness:

• Train new hires and claims teams on fraud red flags and trends
  
• Lead fraud awareness campaigns and maintain a regular training rhythm
  
• Upskill fraud management teams on emerging fraud trends and tools
  

Problem Solving Skills:

• Demonstrate problem-solving ability and decision-making skills
  
• Ability to think creatively, apply practical learning to rectify issues or anticipate problems
  
• Identify suitable solution options and provide recommendations
  
• Ability to build and manage effective projects, perform tasks within guidelines, make recommendations, and exercise decision-making authority
  
• Ensure problems are addressed at the appropriate level and involve others in joint problem-solving efforts
  

Requirements:

• Proven experience in fraud investigation or fraud management within insurance or related industries
  

Initiative and Motivation:

• Self-motivated individual who is proactive and confident
  
• Demonstrated ability to work under pressure, achieve outcomes, prioritize tasks, meet deadlines, and be personally motivated and resilient
  
• Ability to work independently, lead initiatives, and drive delivery
  

Communication Skills:

• High level of written and verbal communication and presentation skills
  
• Ability to present to all levels of management and staff with a high level of detail
  
• Capacity to influence and negotiate at all levels of management and staff
  
• Ability to analyze, interpret, and disseminate information in a manner suitable for all employees and stakeholders
  

Professional Qualities:

• High level of professionalism, maturity, and integrity in interactions
  
• Strong customer focus
  
• Motivated to succeed in a challenging environment
  
• Intermediate skill level computer literacy with Microsoft Office suite
  
• Commitment to promoting a positive process improvement focus
  

About Our Organization:

Our organization is a trusted leader in the insurance and asset management industry. We care about our employees' ambitions, dreams, and challenges. Together, we can create an environment where everyone feels empowered and has the confidence to explore, grow, and shape a better future for our customers and the world around us.

We value diversity and inclusion in our workforce and are proud to be an equal opportunity employer. We encourage you to bring your whole self to work, regardless of your background, age, gender, nationality, religion, disability, or sexual orientation.

Details:
Seniority Level:

• Mid-Senior Level

Employment Type:

• Full-time

Job Function:

• Project Management and Information Technology

Industries:

• Financial Services and Insurance

Location: Brisbane, Queensland, Australia

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