My client is one of the insurance firms in Hong Kong, they are seeking an experienced Fraud Claims Specialist to join on a 12-month contract. This role is ideal for someone with deep insurance expertise, strong leadership skills, and a passion for strengthening operational integrity and customer protection.
What You'll Do
- Review operations and workflows to identify gaps, improve efficiency, and strengthen FWA controls, particularly within the Claims department.
- Stay updated on regulatory changes and ensure all practices meet compliance standards.
- Collaborate with cross-functional teams (e.g., Underwriting, Customer Service, IT, Finance, Compliance) to manage and mitigate FWA risks.
- Use data analytics and reporting insights to enhance controls and support informed decision-making.
- Lead claims strategy execution with a strong focus on FWA awareness and prevention.
- Prepare for audits and ensure operational workflows meet regulatory and internal requirements.
- Support digitalisation, product launch, compliance, and process improvement projects-embedding FWA safeguards throughout.
- Act as Subject-Matter Expert for claims-related system enhancements; partner with IT for requirements and UAT.
- Maintain and update the FWA/Claims/Audit Rules Master List.
- Serve as Fraud Ambassador-raising awareness, sharing insights, and driving continuous improvement.
- Lead the FWA framework, oversee fraud alerts, and ensure timely escalation and case resolution.
- Reconcile fraud dispute cases and ensure accurate reporting.
✔ What We're Looking For
- Bachelor's degree in Business, Finance, Insurance, or related fields.
- 10+ years of insurance experience, with a strong focus on FWA management, medical insurance, claims fraud, and project execution.
- 5+ years of leadership experience with a proven ability to lead teams and collaborate across functions.
- Strong understanding of insurance and healthcare regulations, with solid medical knowledge relevant to fraud analysis.
- Advanced experience in financial crime investigation and risk management.
- High proficiency in MS Office and strong analytical skills, especially in data interpretation and systems analysis.
- Strong investigative, reporting, and communication skills.
- Detail-oriented, resilient, and effective under pressure.
- Ability to analyse large datasets and make sound, independent decisions.
- Fluent in English and Cantonese (written and spoken).
If you're interested in this role, click 'apply now' to forward an up-to-date copy of your CV, or call us now.
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