Fraud Management Manager

MISSION:
Lead the strategy for preventing, detecting and investigating fraud, abuse and waste in claims for Personal Lines, Life and Health Benefits, 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 personal claims and life and health benefits.
2. Establish criteria, priorities and action models that ensure effective detection, balancing economic impact, customer experience and reputational risk.
3. Drive fraud detection through manual, technological and industry channels, promoting the use of analytical tools, automatic alerts, reporting and artificial intelligence models.
4. Ensure the triage and prioritisation of alerts and suspicions, optimising investigative capacity and minimising unnecessary impact on customers and intermediaries.
5. Propose and implement continuous improvements and process simplification through data-driven and artificial intelligence solutions.
6. Plan and manage the investigation of claims and benefits suspected of fraud, abuse or waste across all lines under their responsibility.
7. Define the approach for each investigation, coordinating the involvement of specialised providers: medical centres, investigators, lawyers, loss adjusters or other professionals.
8. Ensure rigorous and confidential management of information, especially sensitive data, guaranteeing regulatory compliance and quality in service to customers and distributors.
9. Contribute to the technical result of the line through the savings achieved, optimising the average claims cost, management expenses and reserve control within their scope of action.
10. Direct and oversee the management of external providers related to anti-fraud activity, ensuring their efficiency, quality and cost.
11. Foster a cross-cutting anti-fraud culture, developing specific knowledge and skills through continuous interaction with teams within the area and other areas of the company.
12. Encourage detection through the various manual channels (managers, authorisations and delegated invoice control, etc.), technological channels (PowerBI, automatic systems, Shift, Casandra, etc.) and industry channels (SENDA).

Education:
-Bachelor's degree in Actuarial Sciences, Economics, Business Administration, Law, Engineering, Mathematics, Statistics, Medicine or similar.
-Postgraduate degree or master's in Fraud Management, Data Analytics / Big Data, Artificial Intelligence applied to 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
with external providers (medical centres, hospital groups, investigators, lawyers, loss adjusters).
-Deep knowledge of claims and benefits processes in Health (medical panel, billing, authorisations), fraud typologies, abuse and waste.
Technical impact on reserves and line results.
-Data analysis applied to fraud. Reporting and BI tools (Power BI or others). AI / machine learning models applied to business. Industry tools (SENDA or others).

Competencies:
-Analytical ability and critical thinking to detect suspicious patterns.
-Knowledge of investigation techniques and forensic analysis.
-Negotiation skills with excellent communication ability (verbal and written).
-Cross-functional mindset and ease of teamwork in multidisciplinary environments.
-Command of technological tools and specialised software for fraud detection.
-Results orientation and continuous improvement in control and detection processes.

-Advanced English

AXA Spain is one of the most relevant Talent Centers for AXA, with over 3,000 employees working on local and international projects.

We are proud to have been awarded various 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, protecting what matters. We create sustainable long-term value while protecting our clients, 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, 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