18 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 a...

All Risk Claims Management Implement Claims SOP within the team and service network and ensure adherence of the same in region Monitoring day to day claims activities and ensure claim settlement as per agreed TAT at region Guide and direct the team member in handling critical claims End to End claims processing, approving/repudiating claims considering policy terms and conditions Ensure up to date data entry in Claims Module by ASPs/Self and team members and document collections required for claims processing Interact with Service Providers’/logistic partners for timely service delivery and monitor service providers payments Updating customers about the claim’s status ACS Control and Loss Mi...

Team Management Participate in recruitment process to identify the right talent within the function Guide and direct the team in efficiently achieving their targets Establish individual performance expectations and regularly review individual performance of the team. Identify and create development opportunities for team members to enhance functional knowledge Non Motor Claims Management Implement Claims SOP within the team and ensure adherence of the same. Handle large claim data and work load distribution within the team based on claims volume Monitoring day to day claims activities and ensure claim settlement as per agreed TAT Guide and direct the team member in handling large claim data ...

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 a...

All Risk Claims Management Implement Claims SOP within the team and service network and ensure adherence of the same in region Monitoring day to day claims activities and ensure claim settlement as per agreed TAT at region Guide and direct the team member in handling critical claims End to End claims processing, approving/repudiating claims considering policy terms and conditions Ensure up to date data entry in Claims Module by ASPs/Self and team members and document collections required for claims processing Interact with Service Providers’/logistic partners for timely service delivery and monitor service providers payments Updating customers about the claim’s status ACS Control and Loss Mi...

All Risk Claims Management Implement Claims SOP within the team and service network and ensure adherence of the same in region Monitoring day to day claims activities and ensure claim settlement as per agreed TAT at region Guide and direct the team member in handling critical claims End to End claims processing, approving/repudiating claims considering policy terms and conditions Ensure up to date data entry in Claims Module by ASPs/Self and team members and document collections required for claims processing Interact with Service Providers’/logistic partners for timely service delivery and monitor service providers payments Updating customers about the claim’s status ACS Control and Loss Mi...

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 Ma...

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 Ma...

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 a...

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 Ma...

PRINCIPAL ACCOUNTABILITIES Planning and Preparation: Establish an audit team with appropriate expertise and qualifications. Review relevant regulations, guidelines, and company policies related to network empanelment. Develop an audit plan, including the scope, objectives, timelines, and resource allocation. Communicate the audit plan to relevant stakeholders and obtain necessary approvals. Assessment of Existing Processes: Evaluate the existing network empanelment policies and procedures. Review the criteria and process for the selection, onboarding, and monitoring of third-party service providers. Assess the due diligence and background checks conducted on service providers. Verify complia...

PRINCIPAL ACCOUNTABILITIES Planning and Preparation: Establish an audit team with appropriate expertise and qualifications. Review relevant regulations, guidelines, and company policies related to network empanelment. Develop an audit plan, including the scope, objectives, timelines, and resource allocation. Communicate the audit plan to relevant stakeholders and obtain necessary approvals. Assessment of Existing Processes: Evaluate the existing network empanelment policies and procedures. Review the criteria and process for the selection, onboarding, and monitoring of third-party service providers. Assess the due diligence and background checks conducted on service providers. Verify complia...

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 Ma...

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 a...

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 th...

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 Ma...

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

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 comp...