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Digit Insurance
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Consultant Claims Investigation

Consultant Claims Investigation

Digit Insurance

4 - 8 years

4 - 8 Lacs

bengaluru

Posted:10 hours ago| Platform:

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Skills Required

risk mitigation life insurance compliance legal documentation risk escalation insurance database database querying onboarding medical claims processing fraud detection

Work Mode

Work from Office

Job Type

Full Time

Job Description

Overview

TheClaims Investigator plays a critical role in safeguarding the integrity of lifeinsurance claims by conducting rigorous investigations into potentiallyfraudulent or high-risk cases. The role demands sharp analytical acumen,compliance awareness, and effective coordination with internal teams andexternal agencies. It also includes managing vendors and contributing tocontinuous risk mitigation strategies.

Responsibilities

Conduct thorough investigationson flagged life insurance claims for fraud, anomalies, or discrepancies.
Review and analyze supportingevidence: medical records, PMRs, FIRs, employment history, and police reports.
Collaborate with forensicexperts, legal advisors, and external partners to build a comprehensive case.
Prepare detailed investigationreports highlighting findings, recommended actions, and escalation notes.
Oversee onboarding ofinvestigation vendors and manage fee processing and records.
Monitor investigation KPIs andpublish monthly dashboards on fraud trends, resolution time, and vendorperformance.
Suggest updates to claims processing protocolsand preventive fraud controls based on investigation insights.

Requirements

3-5 years experience ininsurance investigations, fraud detection, law enforcement, or financialcompliance.
Deep understanding ofinvestigation techniques and insurance fraud regulations.
Excellent documentation reviewand information synthesis capabilities.
Skilled in interviewing, withhigh integrity and ethical standards.
Proficiency in investigationtools, MS Office, and basic database querying.
Capable of managing multiple cases with tightdeadlines.

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Consultant Claims Investigation