Fraud Investigator

3 days ago

Manchester, United Kingdom MERJE Ltd Full time

We are currently seeking a highly skilled Fraud Investigator to join our growing team at MERJE Ltd, a leading Insurance group. As a Fraud Investigator, you will be responsible for protecting our business and customers from the impact of fraud.

Key Responsibilities:

  1. Conduct thorough investigations and gather evidence on suspected fraudulent claims for personal injury, vehicle damage, and credit hire.
  2. Carry out telephone interviews with customers and engage external suppliers, including accident investigators, motor engineers, and panel solicitors.
  3. Assess evidence, including intelligence, Police reports, medical records, and engineering evidence, to identify inconsistencies and determine the outcome.
  4. Identify cases of potential Fundamental Dishonesty, private prosecutions, or professional enabler involvement.
  5. Provide advice and support to business areas regarding potential fraud risks.
  6. Process payments on claims files as required and in accordance with authorities.
  7. Ensure claim files are reserved accurately and reserves amended where required.
  8. Meet agreed fraud KPIs and targets.
  9. Ensure compliance with Company financial crime procedures and related policies.
  10. Submit Suspicious Activity Reports as necessary to the Company MLRO.
  11. Ensure compliance with TCF principles when liaising with customers.
  12. Build and maintain relationships both internally and externally.
  13. To be compliant with health and safety policies at all times.
  14. Ensure compliance with company and other relevant standards/regulations at all times.
  15. Produce high-quality written reports and advice for the business, including recommendations.
  16. Any other reasonable duties as required.
  17. Carry out duties, activities, and tasks as directed within the Claims and Fraud pillar.

Experience & Knowledge:

  1. Strong experience of handling fraudulent customer, third-party damage, and personal injury claims.
  2. Proven track record in investigating both opportunistic and organized motor fraud.
  3. Managing a caseload with adherence to SLAs.
  4. Proven track record of stakeholder management.
  5. Strong understanding of motor insurance fraud and the purpose of a Counter Fraud Team.
  6. Strong understanding of the various indemnity levels and the subsequent impact that this may have on the claim/policy.
  7. An understanding of Part 7 and Part 8 Proceedings.
  8. Strong understanding of the litigation process and the impact that this has on the business both procedurally and economically.
  9. Strong understanding of regulatory responsibilities (SMRC).
  10. Excellent knowledge of FCA requirements (including TCF) and the regulatory framework relating to general insurance.

Applicants must be located and eligible to work in the UK without sponsorship.

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