Fraud Analyst

Responsibilities:

- Oversight of Fraud Risk & Abuse control concerning claims.

- Engaging in fraud prevention and detection, remaining informed about the latest developments and procedures in fraud risk management.

- Establishing a Code & Ethics framework to manage consequences effectively.

- Gathering intelligent data (both internal and external), integrating data from various sources and formats.

- Utilizing text analytics to derive additional insights from unstructured data like claim notes and investigation reports.

- Employing advanced claims analytics to subject all suspicious claims to machine learning models.

- Conducting investigations into instances of fraud & misconduct in accordance with organizational guidelines and ensuring appropriate and timely action.

- Developing, reviewing, and implementing Anti-Fraud Policy, Fraud management plan, and Fraud Risk Assurance Frameworks.

- Drafting SOPs on fraud mitigation processes and enhancing them by updating fraud identification triggers regularly.

- Compiling various regulatory and governance reports including FMR, conduct risk metrics, and fraud packets.

- Ensuring comprehensive updates to the Audit Committee regarding existing and potential frauds, as well as control deficiencies.