15 Jun 2017

Full-Time Technical Medical Fraud Lead

Directline Group – Posted by AdminManchester, England, United Kingdom

Job Description

Technical Medical Fraud Lead

Our Counter Fraud function support the claims business by ensuring we only provide policies to genuine people, and only pay out to genuine claimants. To achieve this, we draw from the immense experience of our claims handlers, identify, collate and leverage intelligence from the industry, and use various technical systems to identify claims we believe to be suspicious. It is essential that we minimise the impact on genuine customers, so we are just as concerned with releasing genuine claims as retaining fraudulent ones.

The Technical Medical Fraud Lead is a unique and visionary position that requires key core skills and a detailed understanding of the medical environment including regulations as outlined within the General Medical Council (GMC) and Health Care Professions Council (HCPC). The role will significantly enhance DLGs financial savings capability in tackling suspected exaggeration and claims fraud within the complex medical environment.

This is a truly unique opportunity to join our Counter Fraud function here at Direct Line Group and this is a permanent position based out of either our Bromley, Birmingham, Leeds or Manchester offices.

Key Accountabilities

  • The post holder will develop a strategic capability, supporting DLGs strategy in successfully identifying and challenging fraud, dishonesty & exaggeration, in order to maximise savings opportunities, minimise risk and exposure.
  • Will be responsible for developing a strategy to successfully tackle all areas of fraud/exaggeration that involve medical practitioners and enablers across all brands in addition to supporting identified brand partners.
  • A national responsibility supporting business areas vulnerable to high risk of medical induced fraud/exaggeration.  The post holder will deliver training and raise awareness on medical fraud issues as well as lead, coordinate and undertake in-depth investigations into medical claims making recommendations and supporting outcomes.
  • The primary focus of this role will be within the Injury and travel medical claims environment.  Supporting DLGs Claims Technical Hub and DLGs input into MedCo.
  • Prepare evidential products to national standards in support of either criminal, civil or tribunal proceedings.
  • Identify, develop and maintain external relationships with bona fide medical forums such as the Health Insurance Counter Fraud Group (HICFG), European Healthcare Fraud & Corruption Network (EHFCN) and Global Healthcare Anti-Fraud Network (GHCAN). Contribute towards other industry leading groups such as IFIG on medical issues.
  • Act as DLGs single point of contact (SPOC) for healthcare regulators such as the GMC, HCPC, GDC and NMC.
  • Support the Intelligence Unit in delivering its key priorities, providing meaningful Intelligence products that will assist DLG in making informed decisions, identifying risk and preventing exposure to fraudulent activity within the Claims, Travel, Policy and wider internal business environments.
  • Actively support the intelligence unit’s contribution to Direct Line Group’s Counter Fraud priorities.
  • Where appropriate act as an SME on behalf of DLG in providing evidence whilst attending court/tribunals and hearings. Contribute on medical issues with LEA investigations as and when required.

Skills we are looking for

  • Extensive experience in medical claims and be a leading figure in this area
  • An individual recognised by the General Medical Council
  • A proven track record in repudiating medical claims, including experience in travel claims
  • Excellent communication skills, both written and oral

Career benefits and rewards

Rewarding you is really important to us, as well as offering a competitive salary and generous holiday entitlement; you can take advantage of a wide range of benefits. The best part is you can pick and choose the benefits to suit your own lifestyle, but also pass on some of the savings to family and friends. Here are just a few we have on offer:

  • A competitive salary, benchmarked against our competitors, which will grow as you do.
  • Pension 9% of your base salary, you can choose to contribute less or more than this, and anything you don’t wish to put in to your pension you can take as cash instead!
  • Private medical insurance (anyone can choose this through our flexible benefits scheme, and managers receive this as standard)
  • Attractive holiday entitlement
  • 50% off our Home, Motor and Pet insurance
  • Free Travel insurance
  • Free Green Flag breakdown cover
  • Flexible rewards including Life insurance, income protection, critical illness insurance, personal accident insurance
  • Retail card, with discounts at big name retailers
  • My Discounts – a discounts website for all our employees, with great discounts, cash back savings and offers across hundreds of brilliant  high street brands, travel, tickets, gym memberships and much more.

Who we are
Direct Line Group is an organisation with a clear mission: to make insurance much easier and better value for customers. We are one of the leading motor, home and small business insurers in the UK. We are home to some of the nation’s best-known brands, including Direct Line, Churchill, Privilege, Green Flag and NIG.

Closing date – Undisclosed

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Job Categories: Other. Job Types: Full-Time and Permanent. Job Tags: Directline Group, diversity, equality, full time, inclusion, manchester, permanent, and Technical Medical Fraud Lead. Salary: Competitive.

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