Lead fraud and claims

Candidate should have experience in Frauds and claims investigation into debit/credit cards and quality-They will be doing the quality checks-Ask whether they are working upstream and downstream

Key Responsibilities1. Operational Leadership & Team Oversight

• Provide day-to-day guidance, coaching, and escalation support to a team of Fraud Analysts and Claims Specialists.

• Monitor team performance metrics (TAT, accuracy, resolution rates, SLA adherence) to maintain high operational standards.

• Conduct regular quality checks, case reviews, and feedback sessions to improve decision-making quality.

2. Complex Case Investigation & Escalations

• Directly handle, analyze, and resolve high-risk, high-value, or complex fraud alerts and disputed claims.

• Conduct root-cause analysis on emerging fraud patterns (e.g., account takeover, identity theft, unauthorized transactions, synthetic identity).

• Coordinate with internal stakeholders (Legal, Compliance, Customer Support) and external bodies (law enforcement, payment networks, partner banks) when necessary.

3. Compliance & Risk Mitigation

• Ensure strict adherence to regulatory standards (e.g., Reg E/Reg Z, AML, KYC, FCRA, or industry-specific insurance regulations).

• Identify control gaps in existing workflows and recommend rule/policy updates to reduce false positives and capture rates.

• Support audit readiness by ensuring clear documentation and tracking across all investigated cases.

4. Process Improvement & Strategy

• Partner with Product, Data Analytics, and Tech teams to optimize automated fraud detection systems and dispute tools.

• Help design and update Standard Operating Procedures (SOPs) for fraud detection, intake, and claim adjudication.

• Track operational data to build executive summaries, fraud loss dashboards, and trend reporting.

Required Qualifications & Skills

• Experience: [4-7+] years of experience in Fraud Operations, Financial Crime, or Claims Processing, with at least [1-3] years in a supervisory or senior lead role.

• Domain Expertise: In-depth knowledge of fraud lifecycles across [Cards / ACH / Wire / Digital Wallets / Insurance Claims / Healthcare].

• Regulatory Knowledge: Solid understanding of financial regulations, dispute guidelines, and AML/KYC standards.

• Analytical Skills: Proficiency with fraud monitoring tools, case management systems, and data analysis software (e.g., SQL, Excel, Tableau, Power BI).

• Communication: Exceptional verbal and written communication skills for de-escalating customer issues and training junior staff.