Head of Fraud and Complaints F/M

AXA

  • Balma, Haute-Garonne Malakoff, Hauts-de-Seine
  • CDI
  • Temps-plein
  • Il y a 1 mois
The Fraud and Claims Manager will have a cross-functional role across operations and geographies, working with local representatives to provide guidance and support on complex and sensitive cases or, escalate sensitive cases to management as directed. He/she will work collaboratively with various teams (IT, Operational Excellence, Data Analysis) to improve management and evolve tools, as well as with non-operational functions (legal, compliance, internal control) as required.Reporting to the Operations Department, and to the Head of Cost Effectiveness, Data Analytics and Governance, your main responsibilities will be as follows:1) On the Fraud side:
- Carry out a fraud risk assessment, identifying the main areas at risk
- Lead the improvement of TIA (premium and claims management tool) and reporting to strengthen fraud detection.
- Facilitate, where necessary, collaboration with local anti-fraud bodies
- Monitor and support Operations Centers on fraud cases
- Explore, implement and manage IT projects with external suppliers concerning fraud detection.2) On the Claims side:
- Monitor claims volumes, trends and KPIs, and work with Operational Centers on in-depth analysis where necessary.
- Ensure a robust process is in place to manage and escalate sensitive claims to management as directed
- Promote the improvement of TIA, procedures and reporting to ensure smooth and standardized claims management
- Ensure and coordinate the organization of the Ex-Gratia Committee.3) Concerning Fraud & Claims:
- Ensure that CLP Operations comply with AXA standards and guidelines and meet regulatory requirements.
- Set up adequate reporting to share with relevant stakeholders and regulators
- Facilitate/mobilize local anti-fraud and claims management communities within Operational Centers by providing support and sharing learnings
- liaise with the Training team to organize anti-fraud and claims management training and procedures, as well as a fraud awareness program
- Update anti-fraud, claims management and litigation guidelines, as well as SCALA controls as required.- Represent CLP on fraud and claims issues (Risk Committee, AXA Partners Committee, Sensitive Cases Committees, Internal Control, Audits)
- Support the TPA Management pillar in matters related to fraud and claims...QualificationsEducation and experience- Proven experience (at least 10 years) at a management level in operations within an insurance company or broker is essential, with solid experience in claims management and the fight against fraud.
- Master's degree in business administration, engineering, actuarial science or underwriting
- Good knowledge of credit and lifestyle insurance in France, as well as foreign markets, is a plus- Fluency in English and French (spoken and written)Skills- Excellent analytical and numerical skills- Ability and confidence to challenge current processes and promote continuous improvement
- Excellent presentation and communication skills (oral and written) and ability to interact at all levels
- Experience in federating a community of experts in an international, multi-site environment
- Strong sense of customer service
- Rigor, attention to detail, strong decision-making skills
- Responsiveness and results orientation
- Proficiency in MS Office applicationsAXA Partners is committed to diversity and inclusion, on an equal basis.Join a company that helps protect the forests! At AXA Partners, we plant a tree for every new recruit (with a permanent contract). Learn more about the Reforest Program#LI-EN

AXA