Director at The Hub of Elevation
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AVP - Fraud Management (11-15 yrs)
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.
- 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
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