Lead- Fraud Monitoring Unit

Role & responsibilities

Lead development and execution in review of Fraud cases recommended by ILM/Claims and decide on the merits of the case and provide concurrence of all such claims.

Oversee review of concluded cases of ILM and the process of providing actionable insights to improve operational effectiveness and decision-making.

Support identification of trends, risks, control gaps, and opportunities for process optimization through analytical reviews and monitoring.

Collaboration With Law Enforcement & Regulators with Law enforcement agencies, Regulatory bodies & National antifraud databases .

Mandatory fraud monitoring frameworks, including Bardapproved Antifraud policies, fraud classification, and reporting mandates.
Supporting regulatory reporting and coordination with fraud bureaus or insurance authorities.

Strengthening internal controls and implementing procedures that reduce fraud opportunities. Educating providers and policyholders on proper practices and fraud awareness

Preferred candidate profile

6+ years of experience in relevant field/claims Investigation.

Claims Analytics, Fraud Analytics or Claims Investigation process.