Job Purpose
Responsible for assisting the Senior Manager in managing the Fraud control operations and taking initiatives as per the SLA pertaining to the assigned verticals in Operations / Accounts departments to ensure smooth and timely resolution of issues in line with regulatory,
organizational and compliance expectations. Also to identify and analyse compliance risk in the operational activities & to contribute to the improvement and strengthen BSLI s operation
functions processes and procedures.
Job Context & Major Challenges
Job Context / Job Challenges
Job Context: Responsible for assisting the Senior Manager in managing the Fraud control operations and taking initiatives as per the SLA pertaining to the assigned verticals in Operations / Accounts departments to ensure smooth and timely resolution of issues in line with regulatory, organizational and compliance expectations. Also to identify and analyse compliance risk in the operational activities & to contribute to the improvement and strengthen BSLI s operation functions processes and procedures. Job Challenges: Managing a significant increase in Frauds, particularly in fake claims due to high repudiations Overcoming constraints in terms of the accuracy of data available in our systems While investigating/analysing various cases, there is no consolidated window containing all information: different systems need to be accessed across the organization Constraints in terms of receiving timely & qualitative responses on cases under investigation from agents/ channel partners and other functions Ensuring adequate mind space especially among sales force & agents on adherence to regulatory/organisational compliance requirements in order to create a fine balance between quantity & quality of business Constraints in tracing the concerned sales persons as they leave the system bef ore the complaints are made Ensuring that the Company keeps pace with a fast
evolving regulatory environment & competitive market practices.
Key Result Areas
KRA (Accountabilities) (Max 1325 Characters)Supporting Actions (Max 1325 Characters)
KRA1 Identify, analyse and report Compliance-related risks in processes related to the assigned verticals in Operations 1. Assist in evaluating and analyzing all the procedures,
policies and process of New Business, Underwriting and
Claims Function. 2. Identify, evaluate and report the
compliance risks within the operation function verticals
assigned 3. Assisting in identifying deficiencies in
policies, process and procedures related to assigned
operational entities and recommend corrective actions to
the Management. 4. Monitor the work carried out by the
assigned operational entities. 5. Assist in providing
recommendations to Strengthen & streamline processes
of operation functions 6. Organize, co-ordinate and
structure compliance related decentralized controls 7.
Assist in implementation of preventive actions in the
processes and procedures.
KRA2 Post Facto analyse and report on the sample policies and recommend corrective actions 1. Conduct checks on sample policies received by operational entities and analyze them, preparation of a report leading to process improvement or strengthening
process wherever required 2. Assist in providing
recommendations to Strengthen & streamline processes
of operation functions 3. Organize, co-ordinate and
structure compliance related decentralized controls 4.
Assist in implementation of corrective actions in the
processes and procedures
KRA3 Mystery Shopping & Checks for identifying and mitigating fraudulent activities 1. Conduct Mystery shopping at the empanelled medical
centers and other BSLI branches for detecting fraudulent
activities (PAN India) pertaining to the operational entities
- Conduct System checks thereby placing controls to
mitigate fraudulent activities. 3. Black Box Audit to be
conducted on a Monthly basis to check the quality of
Business underwritten by Aura and provide a report and
recommendation to the department. 4. Analyzing the
entire claims data of the country, surrender/partial
Withdrawal cases and coming up with relevant patterns in
order to make stringent processes to curb the same. 5.
Assisting in Open and Discreet verification to be
conducted from time to time in discussion of Underwriting
and Claims team and ensure the reports are circulated as
per the desired timelines.
KRA4 Reporting & MIS 1. Assisting in maintaining proper MIS for each and
providing necessary information as per the requirement.
- Assisting in providing Reports and recommendations to
Senior s and Management as per the requirement.
