Chief Manager - Vigilance

Key Responsibilities:

1. The main responsibility of the Vigilance Officer is to undertake preventive vigilance and anti-corruption measures and also investigate complaints/allegations from Vigilance point of view and report the same.

2. The roles and functions of Vigilance Officer are broadly divided into two sides,

a. On the Preventive Side:

To examine in detail the assigned claim(s) with a view to eliminate/minimize the scope and volume of malpractice.

To identify the sensitive fraud prone spots in the claim(s) and track.

To plan and enforce inspection(s) to identify the malpractice and report.

To carry out other assignments.(Employee Background verification, Hospital Fraud Verification, High Value Personal Accident Policy Proposal Verification, Hospital Empanelment Verification, Complaint on Staff/Agent Verification)

b. On the Punitive Side:

To ensure speedy processing of the assigned claim(s) at all stages.

To report then and there to the Chief Vigilance Officer(s) of their respective jurisdiction on issues/escalations.

To ensure proper maintenance of claim documentation.

To scrutinize the inspection/inquiry with the Vigilance point of view.

To ensure prompt submission of reports on time.

3. On the basis of the jurisdiction, claims have to be verified physically or virtually (based on the claim s requirement or need).

4. Will identify any nexus in connection to the following aspects,

a. Non disclosure of PED.

b. Conversion of OP into IP.

c. Lack of Hospital infrastructure.

d. Claims by hospital staffs.

e. Extended stay duration.

f. Fabrication of documents by hospital or insured.

g. Inflated billing.

h. Nexus between insured, sales team / agent(s) and hospital.

i. Case of non admission.

j. Clinic treatment instead of hospital treatment.

5. To carry out back ground verification and Character & Antecedents of employees shortlisted for enlistment, promotion, advances for purchase of movable/immovable property as the case may be.

6. To carry out background verification of Private Investigators being engaged on contract by the Company.

7. To carry out verification of the proposer of Personal Accident Policies when the Sum Insured is between 3 to 7 Crore.

8. To carry out verification of Hospitals prior to empanelment and any other complaints raised against the Hospitals.

9. Collecting Intelligence on competitors, Hospitals, fraud claims and employees/Agents indulging in misconducts.

10. To carry out verification on the genuineness of complaints received through whistleblower and other complaints which are escalated through HR and other departments to the management.

11. To carry out verification on Legal Cases and Ombudsman Claims

12. To draft police complaints and filing the same with police, follow-up & co-ordination.

Requirements:

1. Experience in Vigilance, compliance or related field.

2. Knowledge of Laws and Regulations.

3. Strong analytical and problem solving skills.

4. Good communication and interpersonal skills.

5. Knowledge of investigation techniques and methodologies.

6. Ability to maintain confidentiality and handle sensitive information.

7. Open to travel across locations PAN India.

8. Officers retired from Police or IB or CBI or CPMF or Defence Intelligence, aged below 65 years.

9. Knowledge of MS Office and E Mail Writing