Fraud Investigation Manager

Job Description Fraud & Investigation Manager

Key Responsibilities:

• Review and decision fraudrelated claims across Health, PA, Motor and other lines of business.
• Conduct Closed File Reviews (CFR) for investigationconcluded cases to ensure accuracy, quality and completeness.
• Undertake pattern detection exercises and drive projects aimed at identifying fraud nexus proactively.
• Evaluate fraud cases recommended by the ILM team and Claims team; assess merits and provide concurrence for further action.
• Review ILM-concluded investigation reports and offer actionable insights to strengthen operational effectiveness and enhance process quality.
• Identify linkages (nexus) between claimants, intermediaries, surveyors, vendors, hospitals, and internal personnel.
• Detect repeated fraud patterns involving recurring networks of individuals or entities.
• Analyze fraud trends across categories and prepare detailed datasets/reports for RMC, Legal and senior management review.

Requirements:

• Minimum 4+ years of experience in claims management, investigation, and FMU operations.
• Strong exposure to fraud investigations across Health, Personal Accident and Motor insurance.
• Ability to interpret complex data, identify anomalies and draw insights.

Interested candidates kindly share resume at [email removed] & [email removed]