Senior Claims Leakage Detection Specialist

Happy People Recursos Humanos; United Arab Emirates; Remote; AED 240,000 - 360,000; Full time

Benefits offered by this job

Fully remote

Job summary

Happy People Recursos Humanos in the United Arab Emirates seeks a Senior Claims Leakage Detection Specialist to identify, quantify, and reduce financial leakage across insurance claims operations. You will analyze data, investigate overpayments, and strengthen controls to improve settlement accuracy and profitability.

You will collaborate with claims, finance, actuarial, audit, and risk teams, develop detection methodologies, dashboards, and remediation plans while ensuring regulatory compliance

Qualifications

• Bachelor's degree in Finance, Accounting, Insurance, Business Analytics, Economics, Risk Management, or a related discipline.
• Typically 7–10 years of relevant experience in insurance claims management, claims auditing, financial analysis, claims quality assurance, or loss control.
• Strong understanding of insurance claims processes, policy coverage interpretation, settlement calculations, reserves, and claims payment controls.
• Demonstrated experience identifying claims errors, overpayments, missed recoveries, operational inefficiencies, or financial control weaknesses.
• Ability to analyze complex claims datasets and investigate anomalies, recurring patterns, and unusual payment behaviors.
• Experience with root cause analysis, financial impact quantification, corrective action tracking, and process improvement initiatives.
• Familiarity with insurance fraud indicators, subrogation, salvage, reinsurance recoveries, and third-party liability processes is advantageous.
• Proficiency in Microsoft Excel and claims management systems; experience with SQL, Python, Power BI, or other analytical tools is highly desirable.
• Ability to design exception-based monitoring, automated detection rules, and performance dashboards.
• Strong understanding of internal controls, audit principles, documentation requirements, and claims governance.

Responsibilities

• Analyze insurance claims data to identify potential leakage arising from overpayments, duplicate payments, incorrect reserves, settlement errors, and inconsistent application of policy terms.
• Develop and implement claims leakage detection methodologies, analytical rules, exception reports, and monitoring controls.
• Review claims files, policy wordings, coverage decisions, invoices, adjuster reports, settlement calculations, and supporting documentation.
• Identify discrepancies between policy coverage, approved claim amounts, contractual limits, deductibles, exclusions, and actual payments.
• Investigate patterns of excessive claims costs, repeated processing errors, unusual settlement trends, and unexplained variations in claims outcomes.
• Assess leakage across relevant insurance lines, including property, casualty, motor, health, liability, specialty, and other applicable portfolios.
• Analyze claims handling processes to identify inefficiencies, control gaps, missed recovery opportunities, and avoidable administrative costs.
• Evaluate the accuracy of indemnity payments, expense reimbursements, reserve adjustments, and third-party settlement amounts.
• Identify opportunities to improve subrogation, salvage recovery, contribution, reinsurance recoveries, and other applicable recovery processes.
• Collaborate with claims handlers, adjusters, legal teams, finance specialists, and fraud investigators to validate findings and determine root causes.
• Quantify identified leakage, estimate potential financial impact, and prioritize remediation activities according to materiality and risk.
• Distinguish genuine leakage from legitimate claims variations, approved exceptions, and appropriate customer settlements.
• Develop dashboards and management reports covering leakage trends, root causes, recovery outcomes, control effectiveness, and remediation progress.
• Support claims audits, targeted file reviews, quality assurance exercises, and investigations into recurring processing deficiencies.
• Recommend improvements to claims procedures, delegated authority controls, payment validation, system configurations, and staff training.
• Monitor corrective actions and assess whether implemented controls reduce recurring leakage and improve claims accuracy.
• Maintain clear documentation of analytical methods, findings, supporting evidence, and remediation recommendations.
• Ensure all detection and investigation activities comply with applicable privacy requirements, internal governance standards, and regulatory obligations.

Skills

Analytical thinking

Investigative skills

Communication

Problem solving

Data analysis

Cross-functional collaboration

Financial investigation

Auditing

Education

Bachelor's degree in Finance, Accounting, Insurance, Business Analytics, Economics, Risk Management, or related

Tools

Excel

SQL

Python

Power BI

Claims management systems

Job description

Job Details

Location: UAE (Remote)

Employment Type: Full-Time

Work Arrangement: Fully Remote

Level: Senior

About Us

We are seeking an experienced Senior Claims Leakage Detection Specialist to identify, investigate, quantify, and reduce financial leakage across insurance claims operations. This role focuses on detecting overpayments, under-recoveries, processing errors, control weaknesses, inappropriate settlements, and missed recovery opportunities that affect claims accuracy and profitability.

The successful candidate will combine insurance claims expertise, data analysis, financial investigation, and process improvement skills to strengthen claims controls, improve settlement accuracy, and support sustainable claims performance. The role will work closely with claims operations, finance, actuarial, fraud investigation, audit, and risk management teams.

Key Responsibilities

• Analyze insurance claims data to identify potential leakage arising from overpayments, duplicate payments, incorrect reserves, settlement errors, and inconsistent application of policy terms.
• Develop and implement claims leakage detection methodologies, analytical rules, exception reports, and monitoring controls.
• Review claims files, policy wordings, coverage decisions, invoices, adjuster reports, settlement calculations, and supporting documentation.
• Identify discrepancies between policy coverage, approved claim amounts, contractual limits, deductibles, exclusions, and actual payments.
• Investigate patterns of excessive claims costs, repeated processing errors, unusual settlement trends, and unexplained variations in claims outcomes.
• Assess leakage across relevant insurance lines, including property, casualty, motor, health, liability, specialty, and other applicable portfolios.
• Analyze claims handling processes to identify inefficiencies, control gaps, missed recovery opportunities, and avoidable administrative costs.
• Evaluate the accuracy of indemnity payments, expense reimbursements, reserve adjustments, and third-party settlement amounts.
• Identify opportunities to improve subrogation, salvage recovery, contribution, reinsurance recoveries, and other applicable recovery processes.
• Collaborate with claims handlers, adjusters, legal teams, finance specialists, and fraud investigators to validate findings and determine root causes.
• Quantify identified leakage, estimate potential financial impact, and prioritize remediation activities according to materiality and risk.
• Distinguish genuine leakage from legitimate claims variations, approved exceptions, and appropriate customer settlements.
• Develop dashboards and management reports covering leakage trends, root causes, recovery outcomes, control effectiveness, and remediation progress.
• Support claims audits, targeted file reviews, quality assurance exercises, and investigations into recurring processing deficiencies.
• Recommend improvements to claims procedures, delegated authority controls, payment validation, system configurations, and staff training.
• Monitor corrective actions and assess whether implemented controls reduce recurring leakage and improve claims accuracy.
• Maintain clear documentation of analytical methods, findings, supporting evidence, and remediation recommendations.
• Ensure all detection and investigation activities comply with applicable privacy requirements, internal governance standards, and regulatory obligations.

Qualifications and Experience

• Bachelor's degree in Finance, Accounting, Insurance, Business Analytics, Economics, Risk Management, or a related discipline.
• Typically 7–10 years of relevant experience in insurance claims management, claims auditing, financial analysis, claims quality assurance, or loss control.
• Strong understanding of insurance claims processes, policy coverage interpretation, settlement calculations, reserves, and claims payment controls.
• Demonstrated experience identifying claims errors, overpayments, missed recoveries, operational inefficiencies, or financial control weaknesses.
• Ability to analyze complex claims datasets and investigate anomalies, recurring patterns, and unusual payment behaviors.
• Experience with root cause analysis, financial impact quantification, corrective action tracking, and process improvement initiatives.
• Familiarity with insurance fraud indicators, subrogation, salvage, reinsurance recoveries, and third-party liability processes is advantageous.
• Proficiency in Microsoft Excel and claims management systems; experience with SQL, Python, Power BI, or other analytical tools is highly desirable.
• Ability to design exception-based monitoring, automated detection rules, and performance dashboards.
• Strong understanding of internal controls, audit principles, documentation requirements, and claims governance.
• Excellent analytical, investigative, problem-solving, and communication skills.
• Ability to present findings clearly and objectively to operational teams, senior management, and audit stakeholders.
• Relevant qualifications such as ACII, CII, AIC, CFE, or equivalent insurance, claims, audit, or fraud investigation credentials are advantageous.
• Ability to work independently in a fully remote environment and coordinate effectively with cross-functional teams.

Key Performance Indicators (KPIs)

• Leakage Detection Accuracy: Reliability of identified exceptions and confirmed claims leakage findings.
• Financial Impact Identified: Value of validated leakage detected and documented through approved review methodologies.
• Recovery and Cost Avoidance: Amount of eligible recoveries secured and preventable future losses avoided, measured separately where appropriate.
• Detection Turnaround Time: Timeliness of reviewing flagged claims and completing investigations.
• Root Cause Resolution: Effectiveness in identifying and addressing underlying causes of recurring leakage.
• Claims Payment Accuracy: Improvement in the accuracy and consistency of claims settlements and payment processing.
• False Positive Rate: Proportion of flagged cases that are determined to be legitimate after review.
• Control Effectiveness: Reduction in repeated errors following the implementation of corrective controls.
• Reporting Quality: Accuracy, completeness, and timeliness of leakage dashboards and management reports.
• Compliance and Documentation: Adherence to claims governance, audit requirements, and investigation documentation standards.
• Process Improvement: Measurable improvements in claims handling efficiency, recovery procedures, and financial control effectiveness.

What We Offer

• Competitive compensation aligned with experience, qualifications, and technical expertise.
• Fully remote working arrangement within the UAE-based employment framework.
• Opportunities to work on complex claims analytics, financial investigations, and insurance cost optimization initiatives.
• Exposure to cross-functional collaboration across claims, finance, actuarial, audit, and risk management.
• Opportunities to implement data-driven detection methods and improve claims operational controls.
• Professional development in claims analytics, insurance risk management, and financial investigation.
• A professional environment that values analytical integrity, evidence-based decisions, accountability, and continuous improvement.