Cost Containment Executive

We are looking for a Cost Containment Executive to join AXA Partners Travel Department in Spain.

You will be accountable for supporting AXA Partners Spain, and international Travel markets including UK, Ireland, France, Spain, Belgium and, potentially, others. Also, AXA Assistance Group strategy and particularly for influencing productivity and profitability through effective monitoring, investigation and feedback of Travel activity.

This will involve – at different times - 3 areas of responsibility:

• Fraud Investigations
• Closed File Review (CFR), Open File Review (OFR) and Process Audits
• Insurance and Client Recoveries

• Conduct fraud investigations in accordance with current AXA methodology.
• The Fraud investigation process shall include:

• Completion of Fraud Tracker to show the process from receipt to closure
• Full investigation of the claim involving circumstance and scenario, previous claim history, validity of documentation, attitude of the claimant as determined by case notes and/or with one-on-one calls using Conversational Management techniques. Investigation may target one or more of the end customer, medical and non-medical providers, leisure providers, rental companies, other 3rd parties and AXA Partners staff.
• Identification of the need to appoint an independent investigator
• Identification of the potential to prove fraudulent practice and the corresponding decision in respect to viability of pursuit (taking into account cost-effectiveness and likelihood of success)

• Participation in an annual review of Fraud methodology to ensure that fraud control practices are up to date, relevant and useful in order to drive improvement.
• In addition to the Fraud Controller tasks as described above the Fraud Controller shall also be available to assist in other areas of Cost Containment. This will primarily include Recoveries and Auditor tasks, but may also include ad-hoc analysis of data related to cost containment initiatives and participation in related Cost Containment projects.

• Identify potential process improvements to enhance operational performance and Cost Containment

• Conducting CFR and OFR Audits in accordance with the annual audit plan – plus ad-hoc audits as and when the business requires. The audit process shall include:

• Preparation of random and representative audit samples on differing CMS (GWCC & Liberty)
• Completion of a full financial and process audit from Case Opening to Financial Closure on differing markets and client products. The Auditor will also be attentive to Data Protection/GDPR Breaches, Fraud and Recoveries as well as other Cost Containment initiatives (the use of Preferred Network Providers, the inclusion of prompt payment discounts, Flat Free agreements…)
• Lead leakage alignment discussions with both internal teams (Ops, Network, Medical Team) and external clients (Amex, TUI, Coverwise….)
• Preparation of a Final Report for each audit undertaken which shall include detailed Findings & Recommendations, a Level 3 Leakage deep-dive and a corresponding Action Plan
• Follow-up of the Action Plan to ensure implementation

• Participation in an annual review of Audit methodology to ensure that audit practices are both up to date, relevant and useful in order to drive improvement.
• In addition to the Auditor tasks as described above the Auditor shall also be available to assist in other areas of Cost Containment. This will primarily include Fraud and Recoveries tasks, but may also include ad-hoc analysis of data related to cost containment initiatives and participation in related Cost Containment projects.

• Identify potential process improvements to enhance operational performance and Cost Containment

• Pursue all potential recoveries from the point of identification through to receipt of payment. The process shall be managed within a ‘Recoveries Pipeline’ which is made available to the Head of Cost Containment and which shall include full details of:

• Identification of the potential to recover costs in part or full.
• Decision of whether it is viable (in terms of both cost-effectiveness and likelihood of success) to pursue the Recovery.
• Pursuit of viable…