6 Jobs in Lamphel

Job Purpose Formulate a comprehensive, proactive strategy to prevent, detect and respond to integrity threats. Ensures alertness, watchfulness or circumspection and prevent occurrence of any untoward incidents with adverse financial implications for the organization. Quality assessment & control of all Vigilance Report before submission to HR / Legal / WBC Process recommendation to the respective business line, based upon the Root Cause analysis. Team management – Team mentoring, Training & Managerial skills [Field & Central Team] Fraud Risk Assessment – New Trends analysis and triggers evaluation. Implement Desktop Investigation Process Developing Risk mitigation platform to identify risk areas Conduct mystery shopping across business verticals , based on various trigger points Principal Accountabilities Fraud Mitigation Framework: Monitoring fraud trends, investigating emerging threats and quickly developing and deploying new strategies to manage those threats Providing innovative solutions for formation/strengthening of Fraud Risk tools for prevention, detection and monitoring of frauds. Review existing control environment and assess effectiveness against known fraud schemes. Identify control gaps and create insightful analysis to support the implementation of new controls Oversees and conducts the conversion of data into insights that will lead to informed business decisions. Need to handle multiple simultaneous tasks, prioritize work, and remain functional under pressure, and aggressive timelines. Responsible for Using Business Intelligence Metrics and the highest standards of Credit Control for driving the risk management function Fraud Risk Monitoring Oversee the Fraud aspect of customer selection in the end to end digital Journey and business sourcing leave protocol Develop continuous monitoring and improvement of the excellence of the organization's underwriting and operational procedure. Work with external data providers such as Credit Bureaus and other API providers to further streamline credit process by data validation methods. Coordinate with management for assessment of risk quotient new products and processes. Audit And Compliance Handling and issue of orders in appeal, review and revision petitions relating to vigilance matters. Conduct departmental / disciplinary proceedings in vigilance matters, in respect of all employees, including agent. Share IRDA regulatory reports as per the timelines Mystery Audit Developing trigger points based on Loss ratio, Market & Business Inputs, fraud trends Based on trigger inputs designing plan of action for mystery audit Conducting mystery audit across India to expose & prevent fraud practices, Nexus, Scams Training vendors to upscale for the requirement of mystery audit Show more Show less

Liaison with the IT team to build robust ILM management system to reduce time, effort and increase efficiency. Gather requirements from all impacted stakeholders for improvements on the ILM checkers module and identify processes and reports that can be automated in collaboration with the IT development team. Ensure alignment with standard SOPs and provide the business requirement document to the IT team Monitor the project milestones/ changes required to ILM checkers module and coordinate with the IT team to ensure that the project is delivered as per the set time lines. Carryout the UAT testing once a system upgrade has been done to check for efficiency, ease of use and coordinate to get the system bugs fixed for the pilot launch Provide continuous post deployment support Coordinate with IT team for fixing system bugs Monitor the development of entire automation and handles architect of the new modules. The role would articulate the ideas but also balance them against what’s technologically feasible and financially and functionally reasonable Development of the digital tools to improve the department efficiency in Speed and execution Identify new partners in digital Technology which is useful for fraud Mitigation Strategy Oversee the alignment of the claims scoring model with ILM team’s data analytics reports Use business intelligence tools to create automated reports & dashboards as per business requirements Ideate, design and implement system innovation projects that would lead to time & cost savings – e.g. database integration project with courts, RTOs, IIBs to get easy access to the information they maintain Show more Show less

Desktop Investigation Trigger identification through data at intimation/Referral stage Social media searches Cold calling using digital platforms Identify key business people, link analysis Claim Investigation Allocation of assigned claims to respective vendors with case relevant triggers Follow up for IR and TAT management Level 1 QC clearance & validate the submissions against shared triggers Success in claim investigation based upon strong medical & legal evidences Preparing reports based on findings and observations and guide / Gathering and Analyzing the facts and developing & creating evidence which stands in court of law Report submission and coordination with claims team. Evidence Matrix Assurance Ascertain evidence quality as per matrix Validate each & every evidence with the case triggers DMS of hardcopy maintenance Escalation Management Document Complaince through Field Investigation of HVC Further Requirement Complaince OFR and CFR with Stake holders Data Management MIS preparation and report reconciliation Payment reconciliation with Vendors Project tracking Show more Show less

Deterrence Activity Evaluation of evidence and report – to assess the suitability for deterrence activity. Tracking / Monitoring / Responding of correspondence from Law Enforcement Agencies. Responsible for cluster assistance / liaison with CBI / Police & other agencies in the investigation of cases towards logical conclusion. Filing of Police complaint & follow up for charge sheet filing. Show more Show less

Desktop Investigation Trigger identification through data at intimation/Referral stage Social media searches Cold calling using digital platforms Identify key business people, link analysis Claim Investigation Allocation of assigned claims to respective vendors with case relevant triggers Follow up for IR and TAT management Level 1 QC clearance & validate the submissions against shared triggers Success in claim investigation based upon strong medical & legal evidences Preparing reports based on findings and observations and guide / Gathering and Analyzing the facts and developing & creating evidence which stands in court of law Report submission and coordination with claims team. Evidence Matrix Assurance Ascertain evidence quality as per matrix Validate each & every evidence with the case triggers DMS of hardcopy maintenance Escalation Management Document Complaince through Field Investigation of HVC Further Requirement Complaince OFR and CFR with Stake holders Data Management MIS preparation and report reconciliation Payment reconciliation with Vendors Project tracking Vendor Management Vendor Empanelment & Training & Development Ensure the ethics and compliance during managing the external investigators and self- investigation of cases Show more Show less

JOB PURPOSE (Summarize in one statement why your job exists; and how it contributes to the overall mission/objective of the organization.) Overseeing the process of GMC Investigations to Identify Fraud cases / Minimize liability of Company through extensive "in time" investigation and fact finding of all referred and triggered claims Ensure faster in time investigation of cases with minimum expenses to optimize claims cost saving/ recovery revenues. Developing risk management controls, contingency plans and Communicating recommendations to Under writer Developing Analytical Risk for prediction Managing and assisting team members and Responsible for Pan India ORGANISATIONAL CHART (Please complete the organization chart below using only the generic and descriptive job titles.) Comments Xxx PRINCIPAL ACCOUNTABILITIES (List the accountabilities associated with the job.) Investigations & Quality Improvement Quality checks of the Investigations which is assigned through external and internal Vendors Review the evidence/documents collected to analyze the overall fact pattern of claim and provide recommendations Ensure LOB wise target achievement as per AOP Assisting on FIR filing on fraud identified cases Reviewing the forensic experts reports and giving relevant inputs to conclude the facts of the case. Conduct assessments to define and analyze possible risks and initiative projects as a tool of prevention In-depth Investigation of suspected fraud / triggered claims / Critical & High value claims. Responsible to Complete the Case within Stipulated Turn-around Time (TAT) Trigger Management Developing new trigger after analyzing the patterns of losses Recommend, implement and monitor preventative and corrective actions to ensure that quality assurance standards are achieved Evaluate Trigger efficiency and recommend the prioritization Monitor LR and Create new triggers based on the Outliers Risk & People Management Vendor Management – Training the external investigators, Control measures, Quality check for the investigation reports. Design processes to eliminate or mitigate potential risks: Fraud nexus, Location wise severity. Liaison closely with internal (claims, legal team or any team associated and external stakeholders (Lawyers, Police, Hospitals, Govt Missionaries, etc.) 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 Develop contingency plans to manage crises like Disaster claims, Pandemic situations etc. Enhance existing procedures in investigation by deploying new tools Prepare reports, presentations, recommendations and Performance review to Management Monthly Stat report and Sharing with Concern Channels of GMC Conducting meeting with GMC HR for identified fraud and taking actions MAJOR CHALLENGES (Describe the major challenges you face on an on-going basis in carrying out your job.) Managing and influencing external stakeholder interactions As Internal dependencies which are not in direct control are high settling Claims within the TAT becomes challenging Identify and manage biases resulting from manual approach taken in conducting investigation of reported cases Manage high risk of life for team involved in investigation due to increase in number of assaults during investigation. Attract and manage talent efficiently as manpower required needs to have high IQ and orientation for investigation DECISIONS (Mention the key decisions taken by job holder at his end and the decisions for which the job holder goes to superior with options and recommendations or seek approval). Quality check of the investigation report submitted Court cases and giving deposition Decisions to pay on certain claims referred for investigation Develop risk management controls and systems INTERACTIONS (The key working relationships or routine contacts a job holder needs to have INSIDE and OUTSIDE the organization to accomplish the job.) Internal Clients Roles you need to interact with inside the organization to enable success in your day to day work Claims Team [HAT] Legal Team Business Team Under writer -HAT Actuarial External Clients Roles you need to interact with outside the organization to enable success in your day to day work Investigation agents Forensic experts Police Authorities District Administration Data Vendors Automation Partners DIMENSIONS (List the significant numerical data which will reflect the scope and scale of activities concerning this job). Financial Dimensions (These should be quantifiable numerical amounts like annual budgets, project costs, annual revenue, purchase value etc.). Financial impact of INR 100 Cr crore via prevention, mitigation and process enhancement Other Dimensions (Indication of some of the significant volumes associated with the job like number in team/ staff handled etc). Success of cases referred for Investigation Maintaining the Turn Around Time Enhancing the success of cases investigated Vendor Management: Training, Timely payment for the services Total Team Size – 10 Direct Reports – 10 Show more Show less