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11/03 Swarna Singh
Director at The Hub of Elevation

Views:3137 Applications:73 Rec. Actions:Recruiter Actions:2

AVP - Fraud Management (11-15 yrs)

Delhi/NCR/Gurgaon Job Code: 430324

AVP - Fraud Management (Forensic Consulting Background)

The job holder will be primarily responsible for management of risk that the company is exposed to, through fraud & abuse by individuals & institutions.

Key Responsibilities:

- Review reports of suspected fraud to determine need for further investigation.

- Train others in fraud detection and prevention techniques.

- Maintain knowledge of current events and trends in such areas as mechanisms of fraud and techniques of system abuse.

- Evaluate business operations to identify risk areas for fraud.

- Recommend actions in fraud cases.

- Research or evaluate new technologies for use in fraud detection systems.

- Negotiate with responsible parties to arrange for recovery of losses due to fraud.

- Ensuring requisite manpower

- To transfer knowledge and help team members develop to be future ready, thereby creating pool of talented individuals within the team

- Responsibilities include helping team achieve specified objectives

- To carry out continuous improvement initiatives in the processes

- Drive all initiatives planned and keep management updated on regular basis

- Analytics: Building fraud detection models in partnership with actuarial team

- Investigations: Empanel Investigators, assign cases, ensure SLA's are maintained and quality adherence

- Engage with Industry councils (GI), providers, physicians, distributors, et al

- Enhancement & Development of IT systems

- Innovate: Use of behavioral models, social media, etc. for fraud detection

Desired Candidate Profile:

- Should have around 10 to 12 years of experience in Claims/ Risk management and Fraud & Abuse management

- Experience in partner relationship management, provider network and legal representation is desired

- Strong communication and negotiation skills

- Good conflict manager

- Mystery shopping, fraud prevention measures

- Best practices knowledge

- Experience of handling a large team of people with diverse experience and exposure

This job opening was posted long time back. It may not be active. Nor was it removed by the recruiter. Please use your discretion.

Women-friendly workplace:

Maternity and Paternity Benefits

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