Manager Claim and Fraud Detection

Dear Candidate, 

We are hiring Deputy Manager & Manager - Claim and Fraud Detection

Salary upto 16 LPA

The Manager Claims is responsible for maintaining the establishment of claims philosophy and procedures.

The role is also responsible to ensure that the claims activities are well managed at the branch / hub; training of the vendors to ensure quality output; compliance to regulatory, IFIM & other internal guidelines; prepare periodic metrics on claims; implementation of the claims system; assessment and review of claims on an ongoing basis and team management within the Claims Function.

Key Responsibility Areas

Assessment of claims

Claims Process and Procedure

Leadership & Teamwork

Operational Effectiveness & Control

The role has to ensure that the processes and procedures are followed and implemented in such a way that there is a balance maintained between the emotions and the process to ensure that the image of the company is not tarnished.

The job requires an eye for detail to fish out unique fraudulent cases. Decisions relate to the application of established procedures or the choice of alternative approaches.  Varied decision-making may require reasoned estimates based on an understanding of principles and a systematic search for the cause of events from a number of variables.

Claims adjudication task in India is widespread and there is inconsistency in the way the death and the illness records are maintained

Responsible to identify and prevent payment of fraudulent claims. Assess claims and ensure a periodic review of pending claims for expediting decisions. Monitor, generate, understand and interpret reports for various stakeholders.