TP Quality Control - Fraud Risk Management

Role & responsibilities

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TP Claims Quality Control

• Conduct quality audits and reviews of Motor Third-Party (TP) claims files and investigation reports across locations.
• Assess compliance with regulatory guidelines, internal claims procedures, and fraud risk management policies.
• Evaluate claim handling quality and identify deviations, gaps, and potential leakages.
• Ensure consistency in claim assessment and settlement practices across the organization.

Fraud Risk Management

• Identify suspicious claim patterns, fraud indicators, and potential red flags in TP claims.
• Conduct root cause analysis of fraudulent or high-risk claims.
• Work closely with claims, legal, underwriting, and investigation teams to strengthen fraud controls.
• Support fraud detection initiatives and recommend preventive measures to mitigate risks.

Data Analytics & Audit

• Perform regular claims data audits and trend analysis to identify anomalies and risk areas.
• Generate MIS reports, dashboards, and exception reports for management review.
• Utilize analytical insights to recommend improvements in fraud detection and claims quality.

Investigation & Vendor Monitoring

• Review investigation findings submitted by investigators, advocates, and service providers.
• Monitor performance and quality standards of investigation agencies and vendors.
• Ensure timely closure of observations and implementation of corrective actions.

Process Improvement & Controls

• Recommend enhancements in claims processes, fraud triggers, and quality review mechanisms.
• Participate in the development of control frameworks to improve claim governance.
• Assist in automation projects and system enhancement initiatives related to TP claims.

Stakeholder Management

• Coordinate with Claims, Legal, Underwriting, Risk Management, Operations, and IT teams.
• Provide feedback, guidance, and training to claims teams on quality standards and fraud prevention practices.
• Support management with risk assessments and strategic recommendations.

Preferred candidate profile

• Graduate/Post Graduate
• Candidate from General Insurance will be preferred