RESPONSABLE EXPERIENCE CLIENT, RECLAMATIONS & FRAUDE F/H
Core
Manage complex and sensitive claims, coordinate with delegated partners to prevent fraud, and improve customer experience in delegated health and providence management activities.
Role type
Senior claims and fraud prevention manager (delegated management)
Builds
Improved claim resolution processes, fraud prevention mechanisms, and customer experience metrics for delegated partners
Domain
Health insurance and providence (santé prévoyance)
Required skills
Complex claims analysis, stakeholder coordination, root cause analysis, fraud risk identification, process improvement, data analysis, procedure formalization
Preferred skills
Lean management, workshop facilitation, continuous improvement methodologies
Technologies
Office tools, data analysis tools
Responsibilities
Handle complex and sensitive claims, analyze claim situations to identify management dysfunctions, coordinate with internal and external stakeholders, track claims to resolution, identify recurring issues, define escalation circuits, analyze claim motives and customer pain points, cross-reference claim data with service quality indicators, lead root cause analysis, develop fraud prevention training and processes for partners, define fraud prevention KPIs, evaluate action effectiveness, and disseminate best practices
