SENIOR CLAIMS ANALYST

Description

Job Summary: Responsible for conducting complex investigations, preparing conclusive technical opinions, supervising documentation, and proposing improvements, serving as a technical and strategic reference. Key Highlights: 1. Conducting high-complexity investigations and preparing opinions 2. Strategic involvement in fraud identification and risk mitigation 3. Proposing and implementing structural improvements and efficiency enhancements Responsible for conducting high-complexity investigations, preparing conclusive technical opinions, and critically supervising process documentation. Engages in analytical report preparation, providing technical support to the team, clarifying strategic questions, and interfacing with stakeholders—ensuring systemic updates and proposing structural improvements to enhance efficiency and mitigate risks. Requesting and directing complex investigations, defining investigative strategies through analysis of call records, documents, and formulation of in-depth technical questions; Managing and enforcing deadlines and quality standards for reports delivered by third-party providers, ensuring technical compliance; Analyzing high-complexity investigations and preparing well-founded, conclusive technical opinions; Critically evaluating process documentation, validating causal links, motivations, and event impacts; Conducting comprehensive investigations and defining strategic direction for third parties (e.g., expert assessments, specialized investigations, etc.); Guiding investigators on establishing causal links, ensuring technical consistency; Proactively identifying frauds, interfacing with the prevention team, and supporting deeper analyses; Serving as a technical reference for clarifying questions from members and internal departments; Ensuring checklist compliance with critical thinking and a focus on risk mitigation; Reviewing and validating administrative activities, ensuring technical quality and standardization; Guaranteeing accurate and complete data entry and integrity within the system; Monitoring critical deadlines and ensuring SLA compliance, including formal communications; Validating and reviewing technical documents prepared by support teams; Delivering excellent service to internal and external stakeholders; Providing technical support to the team, promoting guidance and analyst development; Interacting with strategic departments to contribute to decision-making; Reporting status, risks, and metrics to management with analytical insight and proactive suggestions; Proposing and implementing structural improvements focused on efficiency, cost reduction, and productivity enhancement; Staying updated on market trends, legislation, and industry best practices; Performing other related duties with a high degree of autonomy and responsibility.