Insurance Anti-Fraud Program Specialist

Why work with us?
The North American branch of Generali Global Assistance offers a diverse and inclusive work environment while employees work towards making real difference in the lives of our clients. As an Organization, we pride ourselves with offering white glove service while being mindful of corporate responsibility and our environmental footprint.
Employees enjoy a plethora of benefits to include:

• A diverse, inclusive, professional work environment
• Flexible work schedules
• Company match on 401(k)
• Competitive Paid Time Off policy
• Generous Employer contribution for health, dental and vision insurance
• Company paid short term and long term disability insurance
• Paid Maternity and Paternity Leave
• Tuition reimbursement
• Company paid life insurance
• Employee Assistance program
• Wellness programs
• Fun employee and company events
• Discounts on travel insurance

Who are we?
Generali Global Assistance is proudly part of the Europ Assistance Group brand and our products utilize a number of corporate and product brands. The brands for our North American team include the following:

• CSA: US travel insurance brand for retail and lodging partners. Learn more here.
• Generali Global Assistance (GGA): The primary Corporate brand in the United States for our travel insurance, travel assistance, identity and cyber protection, and beneficiary companion products. Learn more here.
• GMMI: the industry standard for global medical cost containment and medical risk management solutions. Learn more here.
• Iris, Powered by Generali: identity and digital protection solution. Learn more here.
• Trip Mate: US travel insurance brand for tour operator, cruise and airline partners. Learn more here.

What you'll be doing.
Job Summary:

• Support Claims Teams in North America in becoming Claims anti-fraud best-in-class.

• Define a clear strategy and the key priorities for the anti-fraud Program deployment.
• Be accountable for the fraud targets achievement.
• Build and functionally manage/coach a dedicated investigation team.
• Manage directly the most complex and high value fraud investigations.
• Support building and guarantee the right execution of the various anti-fraud action plans in close collaboration with the different involved Claims Teams.
• Define enhancements of the automatic detection tool(s) in particular with the various Claims transformation project (e.g. claims automation) and guarantee their right and consistent implementation
• Collaborate with UDW Team enabling to consider main fraud trends / scenarios in the T&Cs building / improvements.

Principal Duties and Responsibilities:
Monitor the Fraud KPIs and be accountable for the Fraud target achievement.

• Define, on a collaboration mode, yearly fraud targets with each claim department.
• Consolidate on a regular basis a Fraud Dashboard embedding savings but also operational KPIs split per department, Business Partners, type of claims...
• Set up an adequate governance framework to review results, main cases, trends with the respective claims teams.
• Ensure timely and accurate anti-fraud reporting for compliance and regulation purposes.

Reinforcing detection/repudiation skills of the Claims Teams

• Build and monitor dedicated anti-fraud action plans for each claim department.
• Design and deploy specific and adapted e-Learning modules for claims teams (jointly with the training department).
• Enrich and maintain a Fraud scenario Library as a key input for trainings programs building and anti-fraud tools enrichments projects, through a regular market scanning of the fraudulent trends in Travel Insurance business and through regular interactions with claims teams.

Manage the continuous improvement of the anti-fraud tool

• Manage the various alerts enhancements in the anti-fraud tool.
• Define a clear detection and investigation cycle time consistent with the claims handling process/ IT systems and to be differentiated by level of alert complexity.
• Build and manage an IT Fraud Data Base as key enabler of our anti-fraud tool.

Build and manage a reduced but highly skilled anti-fraud investigation unit

• Build structure and manage an anti-fraud investigation team.
• Define rules of engagement with the claims departments (threshold, types of claims...) and manage the highest-stakes potential fraud claims.
• Drive the performance of external investigation services providers.

Management and leadership

• Act as an anti-fraud expert within the company, supporting peers to continuously improve maturity level.
• Act as point of contact for Europ Assistance Group Anti-Fraud topics.
• With the close support of your direct manager build and maintain a high-performance team-based culture through effective performance management, career development, communication and coaching of staff, and manage all personnel activities of direct reports (i.e., hires, trains, rewards, motivates, disciplines, terminates, performance reviews, and pay discussions).

Other responsibilities as assigned by Senior Director, Claims Technical Excellence.
Required / Desired Knowledge, Experiences and Skills:

• Minimum of 8 years of prior knowledge and experience in healthcare and/or insurance field for processing claims and or anti-fraud management.
• Strong analytical skills required including demonstrated ability to analyze raw data, draw conclusions, and develop actionable recommendations.
• Knowledge of developing standards, procedures, guidelines etc.
• A minimum of 3 years' experience in a management or supervisory role is preferred.
• Must be able to represent the organization in a professional and knowledgeable manner.
• Excellent verbal and written communication skills with ability to manage and prioritize multiple tasks.
• Computer skills necessary to work effectively: Windows Microsoft Word, Excel, and Power Point Proven ability to work under pressure, prioritize work and meet multiple deadlines.
• Excellent interpersonal and relationship building skills with a proven track record of leadership across functional lines that delivers business results.
• Experience or demonstrated knowledge of travel insurance, travel assistance or health care/insurance preferred.
• Excellent problem-solving skills and capability to troubleshoot the most difficult claim issues.

Education/Certifications:
Requirements:

• High School Diploma or Equivalent (GED) required.

Preferred:

• Associate's degree or equivalent

Pay Range: $85k-100k
Where you'll be doing it.
This is a hybrid role based out of our Pembroke Pines, FL or San Diego, CA office. As a hybrid role, you will be working onsite 2-3 days a week and working from home 2-3 days a week.
When you'll be doing it.
While there is some flexibility in the hours, this position will be Monday-Friday during regular business hours (approximately 8:00am-5:00pm). Occasional overtime may be required according to business need.
Apply today to begin your next chapter.
Don't meet every single requirement? At Generali Global Assistance, we are dedicated to building a diverse, inclusive and enriching workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyways. You may be just the right candidate for this or other roles.
California Residents - Privacy Notice for California Residents Seeking Employment with Generali Global Assistance is available here: https://us.generaliglobalassistance.com/privacy-notice-for-california-residents-seeking-employment/
The Company is committed to providing equal employment opportunity in all our employment programs and decisions. Discrimination in employment on the basis of any classification protected under federal, state, or local law is a violation of our policy. Equal employment opportunity is provided to all employees and applicants for employment without regard age, race, color, religion, creed, sex, gender identity, gender expression, transgender status, pregnancy, childbirth, medical conditions related to pregnancy or childbirth, sexual orientation, national origin, ancestry, ethnicity, citizenship, genetic information, marital status, military status, HIV/AIDS status, mental or physical disability, use of a guide or support animal because of blindness, deafness, or physical handicap, or any other legally protected basis under applicable federal, state, or local law. This policy applies to all terms and conditions of employment, including, but not limited to, recruitment and hiring, classification, placement, promotion, termination, reductions in force, recall, transfer, leaves of absences, compensation, and training. Any employees with questions or concerns about equal employment opportunities in the workplace are encouraged to bring these issues to the attention of Human Resources. The Company will not allow any form of retaliation against individuals who raise issues of equal employment opportunity. All Company employees are responsible for complying with the Company's Equal Opportunity Policy. Every employee is to treat all other employees equally and fairly. Violations of this policy may subject an employee to disciplinary action, up to and including termination of employment.