Group Leader Economic Efficiency Audit / BVM 80-100%

Group Leader Economic Efficiency Audit / BVM 80-100% #

Luzern / hybrid

with flexible start date

permanent

With your team, you ensure that invoices, tariffs and suspicious cases are accurately audited and that incorrect or abusive behavior does not remain undetected. In this leadership role, you combine specialist knowledge, decisiveness and a good sense for people. In this way, you make an important contribution to ensuring that benefits are assessed correctly, funds are used effectively and the interests of CSS and its insured persons are protected.

This is what your everyday life looks like ##

• The core: You ensure that benefit and damage cases, invoices and tariffs are systematically audited and that incorrect, uneconomical or abusive claims are processed cleanly.
• You prioritize suspicious cases, clarify them in a structured manner and initiate the necessary steps together with internal specialist departments and external partners.
• In everyday life, you manage the operational goals in the area of WP-BVM and intervene when corrections to quality, priorities or resources are necessary.
• You advise managers, employees and external bodies on questions relating to economic efficiency auditing as well as abuse and fraud prevention.
• From individual cases, tips and data analyses, you recognize patterns and develop effective approaches for further case processing.
• With clean documentation, reliable statistics and regular reporting, you create transparency regarding the benefits and impact of the WP-BVM activity.

What you bring with you ##

• Most important first: You bring several years of leadership experience and lead clearly, reflectively and with coaching competence.
• In your experience backpack is sound practical experience in abuse, fraud or economic efficiency auditing - ideally in an insurance environment or in a criminalistic, legal or medical context.
• You handle legal issues confidently and know the relevant basics in health insurance, social insurance, civil and criminal law.
• Analytical thinking is one of your strengths, and you work confidently with Excel, Word, PowerPoint as well as suitable analysis tools.
• You decide in a solution-oriented manner, set clear priorities and tackle optimizations on your own initiative.
• You express yourself well orally and in writing in German and/or French. Italian, English or an existing network in fraud management are a plus.