Specialist Fraud Prevention Personal Insurance, 60-100%

Specialist Fraud Prevention Personal Insurance (m/f/d), 60-100% The Health Insurance Solutions AG is a service support center founded in 2024 for health, social and private insurers. With high-quality and efficient services from a single source, we support our customers and partners in optimizing their benefit processes and successfully developing further in the insurance market. To strengthen our Insurance Abuse Combatting team, we are looking for the following immediately or by arrangement: Specialist Fraud Prevention Personal Insurance (m/f/d), 60-100% Your Role In fraud prevention for personal insurance, you will take on a responsible and demanding function at the interface of insurance benefits, law and investigations. With your analytical thinking and your sense for complex circumstances, you contribute to detecting abuse at an early stage and making well-founded decisions. You conduct investigations independently, coordinate investigative measures and are in close exchange with internal and external stakeholders. In this way, you make an important contribution to fair and sustainable benefit auditing. For this position, we are looking for either one experienced specialist 100% with expertise in health and personal insurance (KVG, UVG and KTG) or two specialists with 60% each, of which one specializes in health insurance (KVG) and one specializes in personal insurance (UVG/KTG). Your Tasks You independently process claim cases with suspected abuse in health and personal insurance (health insurance and/or accident and daily sickness benefit insurance) and carry out the necessary investigations. You analyze complex facts, evaluate relevant information and use data analysis to uncover irregularities. You plan, coordinate and accompany suitable investigative and clarification measures and assess the results of personal monitoring. You conduct conversations and negotiations with claimants, service providers, legal representatives and other stakeholders, representing the interests of the insurance professionally and confidently. You prepare sanction decisions and criminal complaints with sound professional expertise and accompany criminal and arbitration proceedings. You advise and support internal as well as external stakeholders on technical and legal issues related to fraud prevention and abuse prevention. You convey your expertise in presentations and training and contribute to raising awareness of fraud risks. Your Profile At least 3 years of professional experience in claims management for health and/or personal insurance (KVG and/or UVG and KTG) or in fraud prevention. Further training in the private and/or health insurance sector, for example as an insurance specialist with a federal diploma, insurance economist HF or health insurance specialist with a federal diploma, is an advantage. Strong analytical skills as well as experience in the evaluation and interpretation of complex data and contexts. High decision-making and enforcement skills as well as the ability to act confidently even in demanding conversation and negotiation situations. Very good written and oral communication skills in German. Good French skills are an advantage and facilitate the exchange with customers, service providers and other stakeholders in French-speaking Switzerland. Independent, structured and responsible way of working with high initiative. High integrity, discretion and a strong sense for complex circumstances as well as risk-relevant contexts. What we offer you A versatile and responsible activity with a lot of personal responsibility. A motivated and committed team with flat hierarchies and short decision-making paths. A modern working environment in the latest office premises in the heart of the city of Bern. Attractive development opportunities, numerous benefits and the home office possibility. Are you ready? Then let's grow together! send us your application with CV, diplomas and work certificates via . We look forward to getting to know you! jpidf3908b8jm jit0834jm jiy26jm