Circle Head-ILM-Health

Job Description

Job Purpose Designing and implementing both technical and non-technical training programs, while also overseeing the professional development of the entire GMC team. This includes identifying training needs, facilitating learning sessions, and organizing activities that enhance employee skills and engagement, ultimately ensuring that all team members reach their full potential. Investigations Allocation of assigned claims to respective vendors with case relevant triggers Follow up for Investigation report and TAT management Level 1 QC clearance & validate the submissions against shared triggers Reviewing the Investigations which is assigned through external and internal Vendors Review and research evidence/documents to analyze the overall fact pattern of claim and synthesize data into a professional report with recommendations Prepare and coordinate field assignments to obtain relevant evidence and information Coordinate with Legal team to provide deposition strategies on consumer cases and use law enforcement resources for assistance Field Investigation for the High value cases Meeting with law enforcement agencies like, Police, Law, other Govt agencies in order to take the case into logical conclusion. FIR filing on fraud identified cases Appointing forensic experts on Fire and relevant cases to conclude the facts of the case. Ability to identify the Triggers, do desktop investigation and execute on the field Gathering and Analyzing the facts and developing evidence Ensuring to convert suspect cases into cogent evidences In-depth Investigation of suspected fraud / triggered claims / Critical & High value claims. Responsible to Complete the Case within Stipulated Turn-around Time (TAT) Conduct inquiries to ascertain the fact findings and to gather evidence. Interview suspects and witnesses examine evidence and conduct research through databases and other sources. Risk Management Vendor Management – Training the external investigators, Control measures, Quality check for the investigation reports. Preparing reports based on findings and observations and guide / train the investigators to fulfil the required actions useful from legal point of view. Working in close coordination with Legal / Claims team Manage and prioritize high case load effectively and efficiently to achieve results of Timeline and Success Training, evaluating, supporting the investigators, towards the fulfilment of the required actions Ensure the ethics and compliance during managing the external investigators and self-investigation of cases. Show more Show less