Fraud Control Manager

Role: Fraud Control Manager

Experience: 8 to 12 years

Location(s): Kurla West, Mumbai

Salary: Up to INR 25 LPA (including 10% variable)

1. Job Purpose Statement

·      To lead and operationalize a comprehensive Fraud Risk Management Framework in line with IRDAI guidelines by supporting fraud detection, investigation, reporting, governance, and regulatory compliance & ensuring effective coordination across FCU, IDD, Legal, HR, Business & other support functions and external stakeholders

·      To ensure & expedite arrangement of complete & accurate documentation for speedy settlement of Fraud / Fidelity / Crime related insurance claim

2. Duties & Responsibilities

·      Fraud Case Management & Monitoring

o  Ensure daily collation of fraud cases from all channels

o  Coordination with stakeholders to collect required data in defined templates

o  Ensure timely population of fraud templates as per defined TAT

o  Supervise fraud classification as per guidelines

o  Ensure sanity checks and validation of cases within defined timelines

·      Fraud Investigation & Case Handling

o  Oversee end-to-end fraud investigations conducted by FCU

o  Ensure quality, consistency, and closure timelines of investigations

o  Guide teams in complex/high-value fraud cases

·      Disciplinary & Legal Process Management

o  Ensure structured input to Legal/HR for Show Cause Notices

o  Oversee end-to-end Show Cause Notice process, including:

§ Compilation of responses from employees, customers, and third parties

§ Ensure proper documentation for legal defensibility

§ Coordinate with Legal team for filing of Police FIRs

·      Fraud Monitoring Committee (FMC) Governance

o  Facilitate Fraud Monitoring Committee (FMC) meetings

o  Ensure:

§ Timely calling of FMC

§ Preparation of case updates & action taken reports

§ Circulation of minutes and decisions

§ Track closure of FMC action points

·      Regulatory Reporting & External Coordination

o  Ensure compliance with regulatory reporting requirements of RBI & IRDAI and related query management

o  Oversee coordination with Internal compliance teams, Regulators and auditors

·      Insurance Company & Channel Coordination

o  Ensure timely reporting of fraud cases to insurance companies / intermediary

o  Oversee fraud governance across:

§ Insurance Companies / Intermediary

§ Business & Support Functions

§ Strengthen fraud control mechanisms across distribution ecosystem

o  Coordinate with internal & external stakeholders to ensure availability of complete & accurate documentation required for Fraud / Fidelity / Crime related insurance claims

o  Review documentation before submission for insurance claim

o  Coordinate with all relevant (internal & external) stakeholders & insurance companies to expedite speedy & correct settlement of Fraud / Fidelity / Crime related insurance claims

·      Fraud Risk Framework & Preventive Controls

o  Lead design and periodic update of:

§ Red Flag Indicators (RFI) framework

§ Fraud Risk Management (FRM) Policy

§ Ensure continuous improvement based on:

·      Emerging fraud trends

·      Internal case learnings

o  Establish and supervise Insurance related Fraud Governance in coordination with Fraud Control Unit (FCU), Cross-functional coordination (IDD, Legal, HR, Business & Support functions)

o  Define Roles, responsibilities, escalation matrix and ensure maker-checker controls and audit readiness

·      Technology & Data Analytics for Fraud Detection

o  Drive implementation of:

§ Fraud analytics tools

§ Case management systems

§ Dashboard reporting (aging, trends, categories)

§ Promote data-driven fraud detection

Professional Qualification

10–12 years experience Fraud Risk & Compliance Audit – Insurance Industry

Experience in insurance distribution / bancassurance

 Knowledge

• Strong understanding of: Insurance distribution & operations
• IRDAI fraud regulations & compliance
• Expertise in:
• Fraud investigation & analytics
• Regulatory reporting