Incident Officer

The Incident Officer is responsible for detecting, monitoring, reviewing, and analyzing people related incidents within the organization and its processes, which may lead to unnecessary payments if not detected in time. 
Main responsibilities: 

1. Investigation: 

  • Investigate complex cases, parties involved victims and witnesses regarding suspicious and/or fraudulent activities within all insurance schemes not limited to agent and brokers, underwriting irregularities, vehicle-, property-, life-, liability- and health insurance. Conduct investigations involving more than one claimant, victim, and/or issue including those of possible or probable fraud. 
  • Conduct investigations to determine which loophole or exploit was used and whether it was a system, human error and/ or process flaw to take corrective preventive actions. 
  • Gather and record evidential facts, analyze data, prepare investigative summary reports and letters, and present findings to management and if needed to law enforcement for prosecution. 
  • Coordinate fraud cases. 
  • Review and research evidence document to analyze overall fact pattern and synthesize data into reports with recommendations. 
  • Perform and/or review business risk assessment identifying the areas of potential misuse, assessing the business and operational risk landscape, devising concrete processes and mechanisms to seal any loopholes that exist within the business environment to mitigate fraud. 
  • Continuous evaluation of trends in (local and international) insurance market to identify key indicators of unusual and/or suspicious insurance activities and formulate strategies to handle these. 
  • Conduct special investigations as per request of management. 

2. Data analysis: 

  • Utilizes business intelligence software to perform data analysis on insurance transactions trends, analyze patterns and correlations for variances. 
  • Uses problem solving and analytical approaches to design and lead simple data analysis and recommendations. 
  • Leverage claims and underwriting data to identify areas of risk and recommend innovative strategies for mitigation. 
  • Pull, integrate and analyse data from disparate and suggest ways to increase process quality and reduce cost. 
  • Continuous analysis and monitoring of customer database to identify customers that may pose a risk to the company. 
  • Perform detailed analysis on assigned cases and recommend solution. 
  • Designs and presents conclusions using statistical tools outcome. 
  • Analyses and interprets model’s data, providing notations of performance deviations and anomalies. 

3. Communication 

  • Liaise with professionals from various fields internally and/or externally to assess the circumstances and collect field evidence. 
  • Develop and present training to staff for efficient and continuous detection and handling of suspicious and fraudulent activities within the organization. 

4. Reporting  

  • Monitor, register and track cost savings of suspicious and fraudulent activities. 
  • Prepare and present reports of investigation and data analysis conducted to management in order to guide their decisions as well as provide recommendations on appropriate steps necessary. 
  • Report identified anomalies, and weakness to concerning department managers. 
Education & Experience 
  • BSc in Business Administration, Risk Management, or related studies. 
  • 4+ years of relevant work experience in the insurance field. 
  • Strong data intuition. 
  • Strong analytical background is essential. 
  • Proficient with Microsoft Office Applications. 
Skills & Competencies 
  • Able to conduct different inquiries / research methodologies to identify anomalies within the different insurance schemes. 
  • Ability to learn processes and new technology quickly. 
  • Good people skills and able to deal with all levels within the organization. 
  • Display good analytic, interviewing and interrogation skills along with the capability of drafting reports. 
  • Effective verbal and written communication skills. 
  • Able to maintain a high level of professionalism when handling a case to ensure effective and unbiased resolution. 
  • Honest and ethical with high levels of integrity and confidentiality. 
  • Maintain an up-to-date knowledge of insurance fraud trends and changes in the market. 
  • Must perform well in high-energy, dynamic team-oriented environments and individually. 
  • Personal traits include attention to detail, accurate, determined, willing to learn, critical, information gathering and advanced judgement capability. 
     

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