Fraud Management Lead

MISSION: Lead the strategy for preventing, detecting, and investigating fraud, abuse, and waste in Personal Lines, Life, and Health claims, driving the use of data, advanced analytics, and artificial intelligence, with the aim of protecting the technical sustainability of the business, ensuring service quality, and securing efficient cost control. FUNCTIONS: 1. Define and develop the overall fraud management strategy, ensuring continuous improvement in the capacity to detect, prevent, and investigate claims in Personal Lines, Life, and Health. 2. Establish criteria, priorities, and action models that guarantee effective detection, balancing economic impact, customer experience, and reputational risk. 3. Drive fraud detection through manual, technological, and sector-specific channels, promoting the use of analytical tools, automatic alerts, reporting, and artificial intelligence models. 4. Ensure the triage and prioritization of alerts and suspicions, optimizing investigative capacity and minimizing unnecessary impact on customers and intermediaries. 5. Propose and implement continuous improvements and process simplifications through data-driven and AI-based solutions. 6. Plan and manage the investigation of claims and benefits suspected of fraud, abuse, or waste across all lines of business under their responsibility. 7. Define the approach for each investigation, coordinating the involvement of specialized providers: medical centers, lawyers, detectives, experts, or other professionals. 8. Ensure rigorous and confidential management of information, especially sensitive data, guaranteeing regulatory compliance and quality in customer and intermediary service. 9. Contribute to the technical results of the line of business through achieved savings, optimizing average claim costs, administrative expenses, and reserve management within their scope of action. 10. Direct and supervise the management of external providers related to anti-fraud activities, ensuring their efficiency, quality, and cost. 11. Foster a cross-functional anti-fraud culture, developing specific knowledge and competencies through continuous interaction with teams within the department and across the company. 12. Promote detection across different channels: manual (managers, delegated authorizations, and invoice control, etc.), technological (PowerBI, automatic, Shift, Casandra, etc.), and sector-specific (SENDA). PROFILE: EDUCATION: - Bachelor's degree in Actuarial Science, Economics, Business Administration, Law, Engineering, Mathematics, Statistics, Medicine, or similar fields. - Postgraduate degree or master's in Fraud Management, Data Analysis / Big Data, Applied Artificial Intelligence for Business, Insurance (especially Health / Life). KNOWLEDGE: - Proven experience in: Claims management (preferably Health and/or Life), fraud, abuse, and waste prevention and detection. Investigation of complex claims, leading interactions with external providers (medical centers, hospital groups, lawyers, detectives, experts). - Deep knowledge of claims and benefits processes in Health (medical fee schedule, billing, authorizations), fraud, abuse, and waste typologies. Technical impact on reserves and line of business results. - Data analysis applied to fraud. Reporting and BI tools (Power BI or others). AI / machine learning models applied to business. Sector-specific tools (SENDA or others). SKILLS: - Analytical skills and critical thinking to detect suspicious patterns - Knowledge of investigation techniques and forensic analysis. - Negotiation skills with excellent communication abilities (verbal and written) - Cross-functional mindset and ease of teamwork in multidisciplinary environments - Proficiency in technological tools and specialized fraud detection software. - Results orientation and continuous improvement in control and detection processes. - Advanced English. WHY JOIN AXA? AXA Spain is one of AXA's most relevant Talent Hubs, with more than 3,000 employees working on local and international projects. We are proud to have been awarded certifications such as Top Employer and Top LinkedIn Company, thanks to our environment of development, diversity, and inclusion. We work for the progress of society by protecting what matters. We create sustainable long-term value while protecting our customers, our economy, our environment, and society. Here, you can grow professionally, work with flexibility, and be part of a team that drives change and innovation. At AXA, we actively promote Diversity and Inclusion by offering equal opportunities. Possession of a disability certificate will be positively valued. If you are looking for a place to make a difference, we look forward to seeing you at AXA Spain! #LI-HYBRID #LI-BA1