We are seeking a keen analytical mindset Director of Anti-Fraud Investigation & Strategic Operations to lead our Claims Department in identifying, preventing and mitigating activities of fraud, waste and abuse (FWA) in a comprehensive approach. This role is responsible for developing & deploying strategies for proactive management of FWA risks, detecting suspicious patterns or anomalies, taking appropriate action to address FWA behavior and conducting claims investigation. This role involves managing or collaborating with a team of claims professionals, and working closely with other departments to effectively manage FWA risks in claims management.Position Responsibilities:FWA Risk Management:Formulate FWA strategies in alignment with company direction to minimize financial risk.Develop and implement investigation protocol, reporting framework and monitoring mechanism in compliance with company risk management framework, legal and industry regulations.Develop and oversee comprehensive KPIs reporting for evaluating effectiveness in FWA detection and claims investigation process.Prepare and present reports to stakeholders.Operations and Claims InvestigationConduct thorough investigations of suspicious claim cases, compile evidence to support findings and make decisions on claims outcomes.Work closely with different stakeholders (including customers and distributions) and regional office, as well as collaborate with law enforcement or other regulatory agencies if necessary.Regularly audit claims to assess compliance and effectiveness of FWA framework and identify improvement areas.Develop and implement training and awareness programs to keep claims associates up-to-date FWA trends and patterns.Data Analytics and Technology OptimizationConduct detailed analysis to identify any abnormal or unusual claim patterns.Work with data scientists in FWA rule setting in auto-adjudication engines.Collaborate with IT and other stakeholders to evaluate and implement technological solutions and tools to enhance FWA detection.Actively engage in initiatives or projects in relation to FWA in Hong Kong and share best practices across the region.Required Qualifications:Candidates should possess a bachelor's degree in Quantitative Analysis, Finance, Accounting or a related field. A master's degree is preferred.A minimum of 10 years of experience in insurance claims investigation, fraud detection, or a related area is required, with at least 3 to 5 years in a leadership role.Proven track record of experience in insurance claims investigationStrong analytical and decision-making skills, attention to details and critical thinking • Excellent communication, both verbal and written for conducting interviews, preparing reports, and presenting findings to stakeholdersAptitude to learn and keep abreast of latest regulatory changes and compliance frameworkProficiency with data analysis tools, fraud detection software, and other relevant technologies to effectively analyze claims and detect fraud would be advantageousWhen you join our team:We’ll empower you to learn and grow the career you want.We’ll recognize and support you in a flexible environment where well-being and inclusion are more than just words.As part of our global team, we’ll support you in shaping the future you want to see.About Manulife and John HancockManulife Financial Corporation is a leading international financial services provider, helping people make their decisions easier and lives better. To learn more about us, visit .Manulife is an Equal Opportunity EmployerAt Manulife/John Hancock, we embrace our diversity. We strive to attract, develop and retain a workforce that is as diverse as the customers we serve and to foster an inclusive work environment that embraces the strength of cultures and individuals. We are committed to fair recruitment, retention, advancement and compensation, and we administer all of our practices and programs without discrimination on the basis of race, ancestry, place of origin, colour, ethnic origin, citizenship, religion or religious beliefs, creed, sex (including pregnancy and pregnancy-related conditions), sexual orientation, genetic characteristics, veteran status, gender identity, gender expression, age, marital status, family status, disability, or any other ground protected by applicable law.It is our priority to remove barriers to provide equal access to employment. A Human Resources representative will work with applicants who request a reasonable accommodation during the application process. All information shared during the accommodation request process will be stored and used in a manner that is consistent with applicable laws and Manulife/John Hancock policies. To request a reasonable accommodation in the application process, contact .Working Arrangement Hybrid
