Summary
Wataniya Insurance is hiring an Anti-Fraud Officer in Riyadh to identify, investigate, and report suspected fraudulent insurance claims. The role involves reviewing claim evidence, conducting background checks and field visits, preparing investigation reports, and coordinating with departments and relevant authorities. Applicants should have a bachelor’s degree in business administration, accounting, economics, law, or insurance, an IFCE Certificate, and 1–3 years of relevant experience. CFE and CII certifications are preferred.
The posting
As published on wataniya.com.sa. Pulled from the employer's site and shown as they wrote it.
Job Summary
The Anti-Fraud Officer is responsible for detecting, preventing, and reporting fraudulent claims that have indicators of fraud, together with other risk factors and identifying which cases require investigation. Also, reviewing and researching evidence/documents to analyze the overall fact pattern of the claim and synthesize data into recommendations. Preparing and coordinating field assignments to obtain relevant evidence and information.
Job Responsibilities
- Identify and analyse fraud risk in the company’s operation.
- Support, engage, and address fraud related matters by strengthening detection, prevention, and reporting mechanisms.
- Conducting investigations into allegations of fraud, and abuse committed by clients/ third parties against the company.
- Manage and prioritize a large and varied case load effectively and efficiently to achieve positive results.
- Coordinate with other departments where applicable (e.g. Compliance, and Legal… etc,) when relevant.
Job Duties
- Examine Claims to verify its authenticity and possibility of fraud.
- Investigate and obtain information useful in determining if an incident was staged.
- Write reports of an investigation and offer recommendations on ways to limit fraud risks.
- Perform general administration including compiling of evidence, updating the system, written correspondence, report updates of fraud.
- Review Claims information to detect potential fraudulent or abusive billing practices or vulnerabilities in policy and initiate appropriate action.
- Perform background checks on claimant history and records.
- Conduct investigation and research to uncover the pattern of fraud and the parties involved.
- Maintain an up-to-date knowledge of changes/trends in an insurance or financial institution.
- Visit, follow up, and obtain required information from companies and relevant authorities (e.g. Moroor, Najm, Police, Civil Defence…etc,)
- Visit accident locations, vehicles and validate damages done when considered necessary.
- Communicate and follow up on statements/ clarification from parties involved in the accidents.
- Ensure the achievement of the set target for fraudulent claims.
- Share knowledge and expertise with the team and provide support in dealing with issues and challenges.
- Prioritize tasks as per business needs and management instructions.
- Comply with all regulatory requirements to mitigate compliance risks and support the performance of audits by respective departments and competent authorities
- Perform other related duties as required and assigned by management.
Requirements
Educational Background and Certifications:
- Bachelor’s degree in business administration, accounting, economics, , law or insurance
- Required IFCE Certificate
- Preferably holds Certified Fraud Examiner (CFE)
- Preferable holds professional insurance certificates (CII)
Experience:
- 1 -3 years of work experience in Anti-Fraud, Claims, Fraud Management or similar, preferably with financial industry (i.e. insurance, banking).