Manager Claims Fraud Prevention Position Description

**ARPC Position Description**

**Function**:Claims **Classification broadband**:EL1

**Location**:Sydney **Security clearance**:Baseline

**Role Reports to**(role title)**:Head of Technical Claims (HOTC)

**Direct Reports**(role titles)**:Nil

**Purpose of the role**(Why the role exists; how the role contributes to the ARPC’s strategic objectives)

The purpose of this role is to manage ARPC’s claims prevention program of work for both the terrorism and cyclone
pool’s, including of claims leakage/fraud prevention, detection, recovery, and alignment with industry best practice.

**Key Accountabilities** (Key activities, tasks, and outcomes to be achieved)**

Development / Overseeing Reinsurance Claims Leakage and Fraud
- Detection and Prevention**:Develop, implement, and continuously enhance claims leakage and fraud detection

strategies and initiatives to mitigate fraudulent claims. Collaborate with cross functional teams to strengthen anti
- fraud measures.**
- Investigation and Analysis**:Conduct in -depth analysis of claims data and patterns, as well as internal benchmarking

of insurers, to identify high risk claims and potential fraud. Lead the investigation of suspicious claims, using
advanced tools and techniques where required.
- Recovery**:For identified frauds liaise with appropriate parties to take action on recovery.**
- Policy Development: Contribution toward the development of a framework to identify and assess fraud risks, as well
as policies and procedures related to fraud detection reporting and prevention. Ensure compliance with industry
regulations and standards.
- Collaboration: Collaborate with claims and underwriting teams as well as other departments to share information

and improve claims leakage and fraud prevention efforts. Partnership with the Commonwealth Fraud Prevention
Centre for a whole of government approach to fraud detection and management working together on fraud
countermeasures and reporting.**
- Quality Assurance**:Ensure the quality and accuracy of claims audit and fraud investigations, maintaining a high

standard of work while adhering to deadlines.
- Advisory to ARPC teams for both Cyclone and Terrorism Reinsurance
- Support HOTC where required
- Assist the HOTC to provide guidance and comprehensive technical information to the stakeholders in relation to
- reinsurance offered by ARPC.
- Understand claims data to develop insights for stakeholders and understanding insurer performance

Other
- Support and provide back-up in time where there are volume surge/resource constraints for claims payment and
- audit
- Participate in ARPC Corporate projects as and when opportunities arise.
- Champion risk culture values and a strong advocate for good customer outcomes
- Promote continuous improvement to ARPC’s products and services having regard to product assessments, IT
- solution and business efficiencies.
- Identify, communicate, and solve issues within ARPC that arise in the administration of the TCI Act
- Role model ARPC’s Values and Code of Conduct and Capabilities set out in the ARPC’s Capability Framework.

**Working Relationships**(Key stakeholders, clients, customers, suppliers, providers, consultants, etc.)**
- Internal Relationships
- Build and maintain strong relationships with all members of the ARPC team
- External Relationships
- Build and maintain strong relationships with vendors and partners.
- Build and maintain strong relationships within Government particularly Commonwealth Fraud Prevention

Centre and NEMA

**Person specification**

**Qualifications and experience**

**Qualifications**(indicate whether mandatory or desired)
- Bachelor’s degree in a relevant field (e.g. Legal, Business) _Mandatory_

**Experience**(minimum type and level of experience required to perform the role)
- Experience in a similar role within a highly regulated and well-governed environment _Mandatory_
- Demonstrated experience performing both quantitative and qualitative analysis of large data sets to
- identify fraud and leakage _Mandatory_
- Demonstrated ability to summarise and report findings at an executive level internally and externally
- Desired_
- Experience in reinsurance claims for residential property - _Desired_
- Experience supporting policy design and implementation - _Desired_

**Technical Capabilities**(skills, knowledge, technical or specialist capabilities)
- Technical knowledge of insurance, reinsurance, or financial service sector.
- Demonstrable technical capabilities and knowledge of reinsurance principles and practices.
- Demonstrable working knowledge of reinsurance practices.
- Basic statistical analysis and working knowledge of analytical tools
- Can quickly understand systems / processes and identify risks, vulnerabilities, and opportunities for
- improvements.
- Can proactively engage and support stakeholders to achieve common objectives and solutions to problems.
- analysis to improve business processes or outcomes.
- Can communicate effectively a