Assistant Manager - Fraud & Investigation - General Insurance

At Macro level:

Risk management and Control processes.

Audit processes

At micro level :

1. Anti-Fraud Management

a. Proactive measure to prevent fraud at org level.

b. Handling all fraud cases reported to company, getting investigations done with the help from function / external Consultant, periodic follow up, tracking of action items and update on the frauds to the management periodically.

c. Investigation report review

2. RCM updation for new business and up-gradation of existing RCM. This will also increase the following task for the team

a. Preparation and upgradation of RCM

b. Risk Metrics updation / Risk Appetite and review

c. SOP / Process alignment

d. Alignment with Risk Register

e. Data analytics and MIS review (from above RCMs)

3. Risk Review for critical areas / function including reviews as per management request. About 5 areas In 2018-19, we did 3 risk reviews (Travel, Lease Policy, Claims Fraud Guidelines)

4. Help to Auditors

a. Mock IRDA Audit

b. ICOFR, vendor and other internal and external audits

c. Open IRDA / Audit / Risk Review issues, Follow up, Evidence validation and closure

d. SPOC from Risk team to providing all data for any audit (Internal and External)

5. Governance and Committee Management

a. OVM

b. RALMC

c. FCMC

d. Implementation of all Risk Management Policies

e. Review of Risk policies

6. Management of Outsourcing vendor / Incident reporting / tracking monthly compliance data (i.e. 64 VB) and other Adhoc work.