Claims Investigator – Remote (Thailand)

Claims Investigator (Bangkok, Thailand)

Our client, an international insurance and financial services firm located in Bangkok, Thailand is seeking a claims investigator to join their team.

Role Purpose

In a service-based claims environment, the Claims Investigator will be responsible for investigating complex, high risk, and suspected fraudulent claims thoroughly and robustly to ensure claims adjudications are correct.

This includes in-depth investigation of selected claims, identifying and pursuing lines of inquiry, testing the information gathered, and presenting the evidence making recommendations. You will also review colleague’s claims assessments, provide  investigative advice and guidance, and communicate with medical facilities, partner agencies, insured members and other interested parties to gather information, analyze, and evaluate it against the contract terms.

The Claims Investigator is focused on protecting the interests of the insurer whilst also carrying out the role with a service mindset ensuring members receive efficient and effective resolution to their claims.

Responsibilities:

▪ Reviewing claims assessments, identifying and carrying out lines of inquiry to obtain missing or additional information, evaluating strengths and weaknesses in the evidence, and presenting your findings along with recommendations for resolution.
▪ Using your investigative knowledge and experience to robustly and efficiently investigate claims, identify and reduce fraud, and obtain information from the parties involved as well as other sources. Examining documents, testing their integrity, identifying discrepancies and interpreting their significance.
▪ Creating and presenting high quality reports and reviews documenting investigations, critically anaylzing the information gathered, and making recommendations for resolution.
▪ Developing existing, and implementing new, investigation focused policies and processes. Creating and delivering complimentary training to meet the current needs of the team and enhance future capability.
▪ Identifying and suggesting best practice. Working with managers to implement it.

Qualifications

• Excellent interpersonal, written and verbal communication skills to express ideas or
  facts, orally or in writing, in a clear and persuasive manner to interact with clients
  and providers. Ability to critically analyze information and present your findings
  clearly and logically.
• Exceptional time management skills, energetic, and the ability to take a course of
  action to accomplish goals. This includes identifying and pursuing lines of inquiry,
  collaborating with colleagues and prioritising appropriately. The Claims
  Investigator and must have the ability to plan and organize their own work to meet
  deadlines and facilitate efficient turnaround times for claims under
  investigation. This includes identifying opportunities for quick claims resolution
  and at the other end of the scale anticipating and managing organisational
  risk.
• Ability to generate ideas and solutions, finding new and innovative ways to obtain
  information or solve problems.
• Experience using Microsoft applications, including Word, Excel, PowerPoint, and
  Outlook. Use of IT to accurately record, document, and manage investigations.
• Industry knowledge of claims operations, insurance products and the needs of the claims
  industry. You should have investigative, in the insurance, legal, or similar fields.
• Ability to complete your own work, and review other’s work, in detail and with the
  highest level of accuracy. A keen eye to identify discrepancies or errors and
  interpret their significance. Ability to identify gaps in information and formulate
  and pursue lines of enquiry to address them.
• Ability to proactively and reactively engage with clients to manage their claims experience, making it as efficient as positive as possible whilst protecting the interests of the Insurer.