شركة الصقر للتأمين التعاوني تعلن عن وظيفة مدير منع الاحتيال في الدمام

Department: Fraud Prevention

Industry: Insurance

Reports To: Chief Executive Officer (CEO)

Job Purpose

To lead and manage the Company’s Fraud Prevention function by establishing an effective framework for the prevention, detection, investigation, and reporting of fraud risks across insurance operations. The role is responsible for protecting the Company, policyholders, beneficiaries, and other stakeholders from fraudulent activities while ensuring compliance with applicable regulatory requirements and insurance industry standards in Saudi Arabia.

Key Responsibilities

* Develop, implement, and periodically review the Company’s Fraud Prevention Framework, policies, procedures, and controls.

*Develop, implement fraud prevention strategy and plan.

* Conduct and maintain a comprehensive Fraud Risk Assessment covering all insurance activities, products, processes, and distribution channels.

* Identify and assess fraud risks related to claims, underwriting, policy issuance, renewals, premiums, refunds, commissions, providers, intermediaries, and other insurance transactions.

* Establish fraud indicators, red flags, detection rules, and early-warning mechanisms to identify suspicious activities and emerging fraud patterns.

* Monitor and investigate suspected fraudulent insurance claims and transactions involving policyholders, beneficiaries, healthcare providers, repair workshops, brokers, agents, employees, vendors, and other third parties.

* Lead fraud investigations and ensure that cases, evidence, findings, conclusions, and recommendations are properly documented.

* Coordinate with Claims, Underwriting, Medical, Motor, Finance, Legal, Compliance, Risk Management, Internal Audit, IT, Cybersecurity, HR, and other relevant functions when investigating suspected fraud.

* Develop fraud detection methodologies and utilize data analytics to identify unusual claims patterns, suspicious transactions, duplicate claims, inflated claims, misrepresentation, and other potential fraud schemes.

* Maintain a centralized and confidential Fraud Case Register containing suspected and confirmed fraud cases, investigation outcomes, financial impact, recoveries, and corrective actions.

* Escalate material fraud cases and significant fraud risks to the CEO, senior management, and relevant committees in accordance with the Company’s approved governance framework.

* Prepare periodic fraud reports and dashboards covering suspected cases, confirmed cases, financial exposure, prevented losses, recoveries, emerging trends, and corrective actions.

* Recommend appropriate preventive, corrective, disciplinary, contractual, or legal actions based on investigation findings and in coordination with the relevant functions.

* Monitor implementation of corrective actions resulting from fraud investigations and ensure that identified control weaknesses are appropriately addressed.

* Establish and monitor Fraud Key Risk Indicators (KRIs) and Key Performance Indicators (KPIs).

* Assess fraud risks associated with new insurance products, digital channels, systems, partnerships, providers, and significant changes to business processes.

* Support the development of automated fraud detection capabilities and analytical tools within insurance systems.

* Develop and deliver periodic fraud awareness and prevention training to employees and relevant stakeholders.

* Promote a strong anti-fraud culture and encourage timely reporting of suspected fraudulent activities.

* Monitor emerging fraud trends and schemes within the Saudi and international insurance markets and recommend appropriate preventive measures.

* Coordinate with relevant regulatory, law-enforcement, and external authorities when required and in accordance with applicable regulations and Company procedures.

* Ensure confidentiality, integrity, independence, and proper retention of fraud investigation records and supporting evidence.

* Perform any other fraud prevention responsibilities assigned in accordance with applicable regulations and the Company’s governance framework.

Key Insurance Fraud Areas

The Fraud Prevention Manager shall maintain appropriate oversight of fraud risks including, but not limited to:

* Motor Insurance Fraud: staged accidents, inflated repair costs, fabricated damages, duplicate claims, and collusion with service providers.

* Health Insurance Fraud: medically unnecessary services, phantom billing, upcoding, identity misuse, provider collusion, and duplicate billing.

* Property & Casualty Fraud: fabricated losses, inflated damages, deliberate losses, and misrepresentation.

* Underwriting Fraud: false or misleading information provided during policy application, issuance, or renewal.

* Claims Fraud: falsified documents, exaggerated losses, multiple claims for the same incident, and intentional misrepresentation.

* Intermediary Fraud: misconduct or fraudulent activities involving brokers, agents, or other distribution partners.

* Internal Fraud: fraudulent or collusive activities involving employees or individuals with authorized access to Company systems or information.

* Third-Party Fraud: fraudulent activities involving vendors, healthcare providers, repair workshops, assessors, or other service providers.

Qualifications & Experience

* Bachelor’s degree in Insurance, Finance, Accounting, Risk Management, Law, Business Administration, or a related field.

* Professional certification in fraud examination or investigation, such as Certified Fraud Examiner (CFE), is preferred.

* Relevant experience in fraud prevention, fraud investigation, claims investigation, compliance, risk management, or a related control function.

* Previous experience within the insurance or financial services sector is strongly preferred.

* Strong understanding of insurance operations, particularly claims, underwriting, policy administration, and distribution channels.

* Good knowledge of applicable Saudi insurance regulatory requirements and fraud prevention practices.

Required Competencies

* Strong fraud investigation and analytical skills.

* Strong understanding of insurance fraud typologies and red flags.

* Data analysis and pattern-recognition capabilities.

* High level of integrity, confidentiality, independence, and professional judgment.

* Strong report-writing and case-documentation skills.

* Ability to manage sensitive and complex investigations.

* Strong communication and stakeholder-management skills.

* Ability to present significant fraud matters clearly to senior management and relevant committees.

* Knowledge of fraud detection systems, insurance systems, and data analytics tools is preferred.

Key Performance Indicators (KPIs)

* Percentage of fraud cases investigated and closed within established timelines.

* Value of fraudulent claims or transactions prevented or detected.

* Value of financial recoveries resulting from fraud investigations.

* Reduction in recurring fraud patterns and identified control weaknesses.

* Percentage of corrective actions implemented within agreed timelines.

* Fraud Risk Assessment coverage across insurance products and processes.

* Employee completion rate for mandatory fraud awareness training.

* Effectiveness of fraud detection rules and red-flag monitoring.

* Timeliness and quality of fraud reporting to senior management and relevant committees.

Years of Experience: 3-5 Years