Job Description
Function: Claims Classification broadband: EL1
Location: Sydney Security clearance: Baseline
Role Reports to (role title): Head of Technical Claims (HOTC)
Direct Reports (role titles): Nil
Purpose of the role (Why the role exists; how the role contributes to the ARPC’s strategic objectives)
The purpose of this role is to manage ARPC’s claims prevention program of work for both the terrorism and cyclone
pool’s, including of claims leakage/fraud prevention, detection, recovery, and alignment with industry best practice.
Key Accountabilities (Key activities, tasks, and outcomes to be achieved)
Development / Overseeing Reinsurance Claims Leakage and Fraud
Detection and Prevention: Develop, implement, and continuously enhance claims leakage and fraud detection
strategies and initiatives to mitigate fraudulent claims. Collaborate with cross functional teams to strengthen anti-
fraud measures.
Investigation and Analysis: Conduct in -depth analysis of claims data and patterns, as well as internal benchmarking
of insurers, to identify high risk claims and potential fraud. Lead the investigation of suspicious claims, using
advanced tools and techniques where required.
Recovery: For identified frauds liaise with appropriate parties to take action on recovery.
• Policy Development: Contribution toward the development of a framework to identify and assess fraud risks, as well
as policies and procedures related to fraud detection reporting and prevention. Ensure compliance with industry
regulations and standards.
Collaboration: Collaborate with claims and underwriting teams as well as other departments to share information
and improve claims leakage and fraud prevention efforts. Partnership with the Commonwealth Fraud Prevention
Centre for a whole of government approach to fraud detection and management working together on fraud
countermeasures and reporting.
Quality Assurance: Ensure the quality and accuracy of claims audit and fraud investigations, maintaining a high
standard of work while adhering to deadlines.
Advisory to ARPC teams for both Cyclone and Terrorism Reinsurance
Support HOTC where required
Assist the HOTC to provide guidance and comprehensive technical information to the stakeholders in relation to
reinsurance offered by ARPC.
Understand claims data to develop insights for stakeholders and understanding insurer performance
Other
Support and provide back-up in time where there are volume surge/resource constraints for claims payment and
audit
Participate in ARPC Corporate projects as and when opportunities arise.
Champion risk culture values and a strong advocate for good customer outcomes
Promote continuous improvement to ARPC’s products and services having regard to product assessments, IT
solution and business efficiencies.
Identify, communicate, and solve issues within ARPC that arise in the administration of the TCI Act
Role model ARPC’s Values and Code of Conduct and Capabilities set out in the ARPC’s Capability Framework.
Working Relationships (Key stakeholders, clients, customers, suppliers, providers, consultants, etc.)
Internal Relationships
Build and maintain strong relationships with all members of the ARPC team
External Relationships
Build and maintain strong relationships with vendors and partners.
Build and maintain strong relationships within Government particularly Commonwealth Fraud Prevention
Centre and NEMA
Person specification
Qualifications and experience
Qualifications (indicate whether mandatory or desired)
Bachelor’s degree in a relevant field (e.g. Legal, Business) Mandatory
Experience (minimum type and level of experience required to perform the role)
Experience in a similar role within a highly regulated and well-governed environment Mandatory
Demonstrated experience performing both quantitative and qualitative analysis of large data sets to
identify fraud and leakage Mandatory
Demonstrated ability to summarise and report findings at an executive level internally and externally -
Desired
Experience in reinsurance claims for residential property – Desired
Experience supporting policy design and implementation – Desired
Technical Capabilities (skills, knowledge, technical or specialist capabilities)
Technical knowledge of insurance, reinsurance, or financial service sector.
Demonstrable technical capabilities and knowledge of reinsurance principles and practices.
Demonstrable working knowledge of reinsurance practices.
Basic statistical analysis and working knowledge of analytical tools
Can quickly understand systems / processes and identify risks, vulnerabilities, and opportunities for
improvements.
Can proactively engage and support stakeholders to achieve common objectives and solutions to problems.
Can apply risk management processes and techniques such as risk assessment, forensic analysis, and data
analysis to improve business processes or outcomes.
Can communicate effectively and persuasively, both verbally and in writing.
Can translate concepts, processes, and analysis into a simple narrative to inform strategies and decisions.
Can work collaboratively to develop internal and external capability.
Can work flexibly over a range of short- and longer-term projects.
Has experience developing new frameworks, tools, and guidance.
Ability to work autonomously and proactively.
A natural problem solver and trouble shooter
Strong knowledge of the MS Office suite including Word, PowerPoint, and Excel
Deep legislative and regulatory interpretation and application skills
Ability to work as part of a team and autonomously, as a subject matter expert
Courteous assertiveness
Authorities Limits/ Type
Financial Delegations: As per ARPC Financial Delegations
HR Delegations: As per ARPC Enterprise Agreement
Declared Incident (DTI): As per ARPC Response Plan
Additional requirements
ARPC Values
Integrity
Service
Respect
Wellbeing
ARPC Capabilities (Integrated Leadership System)
ARPC Capabilities describe behavioural expectations for all employees, by classification broadband.
Supports strategic thinking
Achieves results.
Cultivates productive working relationships.
Exemplifies personal drive and integrity.
Communicates with influence
Location: Sydney Security clearance: Baseline
Role Reports to (role title): Head of Technical Claims (HOTC)
Direct Reports (role titles): Nil
Purpose of the role (Why the role exists; how the role contributes to the ARPC’s strategic objectives)
The purpose of this role is to manage ARPC’s claims prevention program of work for both the terrorism and cyclone
pool’s, including of claims leakage/fraud prevention, detection, recovery, and alignment with industry best practice.
Key Accountabilities (Key activities, tasks, and outcomes to be achieved)
Development / Overseeing Reinsurance Claims Leakage and Fraud
Detection and Prevention: Develop, implement, and continuously enhance claims leakage and fraud detection
strategies and initiatives to mitigate fraudulent claims. Collaborate with cross functional teams to strengthen anti-
fraud measures.
Investigation and Analysis: Conduct in -depth analysis of claims data and patterns, as well as internal benchmarking
of insurers, to identify high risk claims and potential fraud. Lead the investigation of suspicious claims, using
advanced tools and techniques where required.
Recovery: For identified frauds liaise with appropriate parties to take action on recovery.
• Policy Development: Contribution toward the development of a framework to identify and assess fraud risks, as well
as policies and procedures related to fraud detection reporting and prevention. Ensure compliance with industry
regulations and standards.
Collaboration: Collaborate with claims and underwriting teams as well as other departments to share information
and improve claims leakage and fraud prevention efforts. Partnership with the Commonwealth Fraud Prevention
Centre for a whole of government approach to fraud detection and management working together on fraud
countermeasures and reporting.
Quality Assurance: Ensure the quality and accuracy of claims audit and fraud investigations, maintaining a high
standard of work while adhering to deadlines.
Advisory to ARPC teams for both Cyclone and Terrorism Reinsurance
Support HOTC where required
Assist the HOTC to provide guidance and comprehensive technical information to the stakeholders in relation to
reinsurance offered by ARPC.
Understand claims data to develop insights for stakeholders and understanding insurer performance
Other
Support and provide back-up in time where there are volume surge/resource constraints for claims payment and
audit
Participate in ARPC Corporate projects as and when opportunities arise.
Champion risk culture values and a strong advocate for good customer outcomes
Promote continuous improvement to ARPC’s products and services having regard to product assessments, IT
solution and business efficiencies.
Identify, communicate, and solve issues within ARPC that arise in the administration of the TCI Act
Role model ARPC’s Values and Code of Conduct and Capabilities set out in the ARPC’s Capability Framework.
Working Relationships (Key stakeholders, clients, customers, suppliers, providers, consultants, etc.)
Internal Relationships
Build and maintain strong relationships with all members of the ARPC team
External Relationships
Build and maintain strong relationships with vendors and partners.
Build and maintain strong relationships within Government particularly Commonwealth Fraud Prevention
Centre and NEMA
Person specification
Qualifications and experience
Qualifications (indicate whether mandatory or desired)
Bachelor’s degree in a relevant field (e.g. Legal, Business) Mandatory
Experience (minimum type and level of experience required to perform the role)
Experience in a similar role within a highly regulated and well-governed environment Mandatory
Demonstrated experience performing both quantitative and qualitative analysis of large data sets to
identify fraud and leakage Mandatory
Demonstrated ability to summarise and report findings at an executive level internally and externally -
Desired
Experience in reinsurance claims for residential property – Desired
Experience supporting policy design and implementation – Desired
Technical Capabilities (skills, knowledge, technical or specialist capabilities)
Technical knowledge of insurance, reinsurance, or financial service sector.
Demonstrable technical capabilities and knowledge of reinsurance principles and practices.
Demonstrable working knowledge of reinsurance practices.
Basic statistical analysis and working knowledge of analytical tools
Can quickly understand systems / processes and identify risks, vulnerabilities, and opportunities for
improvements.
Can proactively engage and support stakeholders to achieve common objectives and solutions to problems.
Can apply risk management processes and techniques such as risk assessment, forensic analysis, and data
analysis to improve business processes or outcomes.
Can communicate effectively and persuasively, both verbally and in writing.
Can translate concepts, processes, and analysis into a simple narrative to inform strategies and decisions.
Can work collaboratively to develop internal and external capability.
Can work flexibly over a range of short- and longer-term projects.
Has experience developing new frameworks, tools, and guidance.
Ability to work autonomously and proactively.
A natural problem solver and trouble shooter
Strong knowledge of the MS Office suite including Word, PowerPoint, and Excel
Deep legislative and regulatory interpretation and application skills
Ability to work as part of a team and autonomously, as a subject matter expert
Courteous assertiveness
Authorities Limits/ Type
Financial Delegations: As per ARPC Financial Delegations
HR Delegations: As per ARPC Enterprise Agreement
Declared Incident (DTI): As per ARPC Response Plan
Additional requirements
ARPC Values
Integrity
Service
Respect
Wellbeing
ARPC Capabilities (Integrated Leadership System)
ARPC Capabilities describe behavioural expectations for all employees, by classification broadband.
Supports strategic thinking
Achieves results.
Cultivates productive working relationships.
Exemplifies personal drive and integrity.
Communicates with influence
💡 Quick Summary
Seeking a career-building opportunity? The Manager Claims Fraud Prevention Position Description position is now open for candidates interested in the Government Job Alert sector. This role in Sydney offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in Government Job Alert is a plus.