Director of Insurance Fraud Risk and Prevention

The Director of Fraud Risk and Prevention is responsible for designing, implementing, and maintaining fraud mitigation strategies across SBLI’s life insurance products. This role will lead efforts to proactively identify and prevent fraudulent activity by policyholders and agents, ensuring the protection of the company’s financial health and reputation. The director will also develop fraud detection tools, enhance operational protocols, and collaborate with cross-functional teams to advocate for features that prevent fraudulent activity while optimizing the sale of profitable products.

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Key Responsibilities:

Fraud Prevention Strategy & Product Enhancement:

• Develop and implement fraud prevention frameworks and strategies that safeguard SBLI’s products from misuse, fraud, and financial risk.

• Partner with Product, IT, Underwriting, and Compliance teams to design and advocate for policy features and digital solutions that deter fraudulent activities.

• Partner with Underwriting, Product, and Actuarial teams to refine eligibility criteria, pricing models, and fraud prevention features tailored to SI and FE business risks.

• Assess new technologies (e.g., AI, machine learning, predictive analytics) for fraud detection and integrate them into SBLI’s operational model.

• Conduct risk assessments of new and existing products to identify vulnerabilities and recommend proactive measures.

Fraud Detection & Investigation:

• Design and oversee internal processes for the identification, monitoring, and investigation of suspicious agent or policyholder behavior.

• Establish real-time fraud monitoring mechanisms to detect anomalies and assess potential fraudulent claims, applications, and agent activities.

• Implement a real-time dashboard tracking agent performance to flag high-risk behaviors such as unusually high placement rates, excessive chargebacks, or policyholder complaints.

• Establish post-issue monitoring protocols for SI and FE policies to detect abnormal ownership patterns.

• Work closely with Underwriting, Claims, and Compliance teams to coordinate fraud investigations and execute appropriate actions, including policy rescissions, agent terminations, or legal proceedings.

• Maintain and analyze fraud case data to identify trends and inform future risk mitigation strategies.

Internal Controls & Compliance:

• Collaborate with Legal, Compliance, and Risk Management teams to ensure all fraud prevention measures align with regulatory requirements and industry best practices.

• Partner with Claims to strengthen and speed contestability period reviews for SI and FE death claims, particularly those occurring within the first two years, focusing on medical misrepresentation, agent collusion, or beneficiary fraud.

• Partner with Licensing to develop enhanced pre-appointment screening for agents selling SI and FE products.

• Design and refine fraud-related protocols, ensuring that employees, agents, and business partners are equipped to recognize and report fraudulent behavior.

• Develop and conduct training programs to enhance fraud awareness across SBLI.

Stakeholder Collaboration & Advocacy:

• Act as an internal advocate for fraud prevention, ensuring business leaders understand fraud risks and support mitigation efforts.

• Partner with external fraud prevention networks, regulatory agencies, and law enforcement to stay ahead of evolving fraud schemes and best practices.

• Represent SBLI at industry conferences and fraud prevention forums to enhance the company’s fraud-fighting capabilities.

Qualifications & Experience:

• Bachelor’s degree in Finance, Business Administration, Risk Management, or a related field; Master’s degree or professional certification (CFE, CAMS, CPCU) is a plus.

• Minimum of 7–10 years of experience in fraud risk management, insurance fraud investigation, or a related field, preferably within life insurance.

• Strong knowledge of fraud detection tools, analytics, and investigative methodologies.

• Familiarity with life insurance underwriting, claims processing, and agent management.

• Experience working with regulatory bodies and industry fraud prevention organizations.

• Excellent analytical, problem-solving, and decision-making skills.

• Strong communication and leadership skills, with the ability to drive cross-functional collaboration.

Performance Metrics:

• Reduction in fraudulent claims and policyholder misrepresentations.

• Decrease in agent-related fraud incidents.

• Implementation and adoption of fraud detection tools.

• Compliance with fraud-related regulatory requirements.

• Improved fraud awareness and reporting across SBLI.

Local candidates only, no relocation or sponsorship available.