Technical Claims and Fraud Manager

A day in the life

As the Technical Claims and Fraud Manager at ManyPets, your primary responsibility is to lead and oversee multiple teams and departments to ensure the achievement of Key Performance Indicators (KPIs) and adherence to performance standards. Your role is pivotal in driving outcome-focused management and ensuring that all teams align with our values and objectives.

You will manage and guide your teams, setting clear and measurable objectives that drive performance and foster a culture of excellence. As a key communication liaison, you will bridge the gap between Claims Handlers and their managers, ensuring seamless and effective communication across all levels.

In this role, you will play a crucial part in fraud prevention and detection within the claims process. By implementing robust fraud management strategies, you will ensure that fraudulent activities are identified and addressed swiftly and effectively. Your responsibilities will include conducting detailed investigations, leveraging data analytics to detect suspicious patterns, and collaborating with relevant departments to mitigate fraud risks. You will also work closely with your teams to enhance their fraud detection capabilities, ensuring they are equipped with the necessary tools and training to identify and prevent fraudulent claims. Your efforts in this area will be integral to safeguarding ManyPets against potential financial losses and maintaining the integrity of our claims processes.

Your role will be critical in ensuring that ManyPets maintains its high standards of service and quality while driving continuous improvement within the claims and fraud management functions.

Core deliverables

• Performance Management: Oversee target achievement, productivity analysis, resource management, and commercial expense management to ensure overall contract performance.
• Setting stretch goals: Challenge direct reports to elevate performance through goal setting, performance reviews, and career planning, fostering high-performance teams.
• Developing team managers. Lead and develop team managers to achieve targets and meet customer requirements effectively.
• Resource management: Take ownership of forecasting resource demand to meet SLAs, applying a commercial focus to resource allocation.
• Building relationships: Establish trust with stakeholders through personal integrity and understand their business objectives.  Achieve a balance of service delivery and commercial outcomes.
• Implementing new initiatives: Introduce new initiatives and best practices to keep teams engaged, motivated, and rewarded. Drive continuous improvement in business processes, team management, and overall performance to enhance customer service and manage costs.

Skills and competencies

Performance Management

• Use management information to analyse performance in key result areas across departmental KPIs.
• Understand financial targets and the impact of people costs and waste on the bottom line.
• Set targeted actions to improve performance levels in line with business objectives.
• Utilise quality and quantity measures to ensure competence and compliance within the team.
• Offer daily and weekly feedback on individual performance.
• Coach individual team members in task completion and personal skills development.
• Review team delivery against objectives, hold regular one-on-ones with direct reports, and measure performance consistently across the department.
• Continuously maintain quality, regulatory, and procedural documentation, and SOP.

Setting stretch goals

• Understand and actively use a balanced set of measures to manage department workloads and stakeholders effectively for high performance.
• Regularly maintain a balanced set of measures to enable the setting of ambitious/stretch targets.
• Understand the relationships between measures and their impact on customers and internal stakeholders, continuously raising performance standards.
• Ensure a regular (monthly) "feedback loop" is completed - providing constructive guidance to the team and recognising high standards of service.

Implementing new initiatives

• Regularly assess existing systems and controls to enhance service delivery, streamline processes, and mitigate business risks through targeted actions.
• Implement and maintain robust financial controls to monitor and manage claim expenses and fraud risk effectively.
• Identify end-to-end process improvements that don't meet stakeholder expectations, addressing costly or non-compliant processes to enhance performance.
• Develop and execute strategies to control and reduce overall claim spend, ensuring cost-efficiency without compromising service quality.
• Think creatively to deliver operational excellence, providing support to Team Managers in identifying problem areas, conducting root cause analysis, and removing obstacles to achieve objectives.
• Identify, analyse, and mitigate claim leakage, enhancing profitability and reducing unnecessary costs.
• Oversee and monitor impact of new onboarding and training plans to ensure quick integration into the business and achieve good learning and performance outcomes.

Developing team managers

• Develop high-performance teams through one-on-one sessions, goal setting, performance reviews, and career planning.
• Collaborate with Team Managers to set objectives aimed at improving efficiency, effectiveness, utilisation, quality, service standards, and costs.
• Actively engage with Team Managers to provide support and ensure plans are achieved through active performance management routines.
• Build a strong team of managers, bringing them together frequently to drive best practices and raise standards through insights from management information and interaction to anticipate client concerns and identify solutions.
• Proactively seek opportunities to enhance personal skills and performance, while also developing the talent and capabilities of Team Leaders and direct reports.

Resource management

• Accurately calculate department resource requirements based on actual and predicted work volumes, implementing continuous improvement solutions to enhance accuracy and optimise costs.
• Lead recruitment activities for the team, making decisions on individuals to ensure the team has sufficient staff with the required capability to fulfil its responsibilities.
• Act as point-person for your team to directly handle complex claims and managing referrals from the team and the wider company.

Building relationships

• Handle complex claims with precision, ensuring accurate and timely referrals to specialists when necessary.
• Handle complex claims with precision, ensuring accurate and timely referrals to specialists when necessary.
• Share concise information with stakeholders to facilitate fact-based decision-making in problem-solving, barrier removal, and action setting.
• Communicate and engage with Team Managers and their teams, coaching individuals to improve performance through performance management systems and one-on-one sessions.
• Clearly communicate business and team objectives to the department, gaining commitment to targets and plans.
• Focus on stakeholder communication and engagement, building relationships across Operations and Engineering, Product, and Design (EPD).
• Share successes and learning opportunities to develop and motivate the department.

What success looks like

• You deliver business objectives through setting effective personal and team goals.
• You meet your own targets and have consistent performance against agreed metrics.
• You inspire, support, and develop others to achieve outstanding performance. You are seen as a highly effective, motivating leader.
• You provide clear direction and keep everyone informed about developments and how decisions will impact them.
• You foster an open work environment focused on improvement - using situational leadership, you develop others through feedback and address poor performance.
• You respect colleagues, recognising that the sum of individual efforts can exceed individual contributions.
• You're not afraid to make choices and decisions that benefit the organisation, even if they're unpopular.
• You have the ability to listen, express, and articulate information effectively. You communicate key company messages in an open and straightforward way. You also describe how future success will be measured.
• You contribute through awareness of the market/industry dynamics. You take a long-term view of building sustainable results, controlling team resources and associated costs/budgets.
• You strive to create the best possible experience for customers and key internal stakeholders.
• You're constantly seeking to improve business processes through analysis, problem-solving, and change initiatives. You encourage others to keep stretching themselves to work towards higher standards.
• You get the job done in an efficient way through effective time, task, and financial management. You prioritise tasks and allocate resources wisely to achieve good outcomes.

You actively look to improve your awareness of regulatory changes or process improvements.