Sr. Specialist - Insurance Investigation

Protect What Matters. Investigate With Purpose

At Allianz Ayudhya, we are committed to maintaining the highest standards of integrity, customer trust, and operational excellence. We are looking for an experienced Senior Specialist - Life & Health Insurance Investigation to join our team and play a critical role in safeguarding our business against fraud, misconduct, and financial crime.

This is an exciting opportunity for professionals with a strong background in insurance claims investigation, underwriting, auditing, compliance, or fraud risk management who are passionate about uncovering facts, driving fair outcomes, and protecting both customers and the organization.

What You'll Be Responsible For

Insurance Investigation

• Lead and manage investigations related to underwriting and insurance applications.
• Develop investigation strategies and allocate resources effectively to ensure quality outcomes.
• Conduct detailed fact-finding activities, including information gathering related to medical history, occupation, lifestyle, and risk factors.
• Collaborate with hospitals, medical providers, and external parties to obtain supporting evidence and documentation.
• Prepare comprehensive investigation reports with clear findings and recommendations.
• Ensure investigations are completed within service standards, timelines, and approved budgets.
• Escalate potential fraud cases and coordinate with relevant stakeholders for further action.

Claim Investigation

• Lead investigations involving high-risk or suspicious claims, including critical illness, disability, accidental death, and other complex claim cases.
• Analyse evidence, interview relevant parties, and conduct field investigations when required.
• Review investigation findings and provide recommendations to support fair and accurate claim decisions.
• Partner closely with Claims, Underwriting, Legal, Compliance, and Fraud Management teams.
• Monitor investigation progress and ensure quality and timely case closure.

Fraud, Misconduct & Mis-selling Investigation

• Investigate allegations of fraud, agent misconduct, mis-selling, money game activities, and MLM-related cases.
• Conduct interviews, gather evidence, and perform in-depth assessments to determine case validity.
• Coordinate with law enforcement authorities and external agencies when necessary.
• Prepare investigation reports and present findings to management and relevant committees.
• Recommend corrective actions and support disciplinary or escalation processes.

What We're Looking For

Key Qualifications

• Bachelor's degree or higher in Law, Business Administration, Nursing, Medical Technology, Health Sciences, or related disciplines.
• Minimum 3-5 years of experience in:
• Insurance Investigation
• Claims Management
• Underwriting
• Internal Audit
• Fraud Investigation
• Compliance or Risk Management within insurance
• Strong knowledge of insurance products, claims assessment, underwriting practices, and fraud detection techniques.
• Experience conducting interviews, field investigations, and evidence evaluation.
• Ability to prepare professional investigation reports and communicate findings effectively.
• Strong analytical thinking, problem-solving, and decision-making skills.
• High level of integrity, professionalism, and confidentiality.

Preferred Qualifications

• Knowledge of insurance regulations and legal investigation procedures.
• Experience handling complex fraud, misconduct, or financial crime investigations.
• Familiarity with data analytics tools such as Power BI, Tableau, SQL, Python, or similar platforms.
• Established network with hospitals, medical providers, or law enforcement agencies is a plus.

• Any AI-future skills e.g., ChatGPT, or CoPilot365, will be advantage.

Why Join Allianz Ayudhya?

• Make a meaningful impact by protecting customers and the business from fraud and misconduct.
• Work on high-profile and complex investigation cases.
• Collaborate with experienced professionals across Claims, Underwriting, Legal, Compliance, and Risk functions.
• Expand your expertise in insurance fraud prevention and investigation management.
• Be part of a leading global insurer with strong career growth and development opportunities.

Allianz Group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams and challenges is what makes us a unique employer. We are united by a shared commitment: to put our customers first and at the centre of everything we do. Their needs inspire our thinking and guide our actions. Together, we can build an environment where everyone feels empowered and confident to explore, grow and shape a better future – for our customers and for the world around us. At Allianz, we stand for unity: we believe that a united world is a more prosperous world, and we are dedicated to consistently advocating for equal opportunities for all. The foundation for this is our inclusive workplace, where people and performance both matter, and where integrity, fairness, inclusion and trust are at the heart of our culture. We therefore welcome applications regardless of ethnicity or cultural Internal background, age, gender, nationality, religion, social class, disability or sexual orientation, or any other characteristics protected under applicable local laws and regulations.

Join us. Let's care for tomorrow.