Job Description - Lead Market Conduct & Fraud Risk Management

Regulatory Framework: Governed by the provisions, regulations, guidelines, circulars and directions issued by the Insurance Regulatory and Development Authority of India (IRDAI)

Position Summary

The Market Conduct Professional will be responsible for ensuring that the health insurance company conducts its business in a fair, transparent, ethical and customer-centric manner in compliance with applicable IRDAI regulations, consumer protection requirements, and internal governance standards.

The role involves monitoring sales and distribution practices, intermediary oversight, and conduct risk management across the organization.

The incumbent shall work closely with Compliance, Legal, Risk, Operations, Underwriting, Claims, Distribution, Customer Service, Product, and Internal Audit teams to strengthen market conduct culture and regulatory adherence.

Key Responsibilities

Regulatory Compliance & Market Conduct Oversight

* Monitor compliance with applicable IRDAI regulations, master circulars, and guidelines relating to Fraud Risk Management and conduct matters as prescribed in Policyholder Protection and Corporate governance regulations

* Assess implementation of regulatory changes and advise internal stakeholders on conduct-related implications.

* Support preparation and submission of regulatory reports, certifications and responses to IRDAI observations, inspections and thematic reviews.

* Maintain market conduct compliance trackers, dashboards and escalation matrices.

Conduct Risk Management

* Identify, assess and monitor conduct risks arising from:

* Sales practices

* Distribution channels

* Claims handling

* Customer communications

* Third-party service providers

* Digital platforms and telemarketing activities

* Develop and implement conduct risk indicators (KRIs), monitoring frameworks and control mechanisms.





* Conduct periodic conduct risk assessments and recommend corrective actions.

Sales & Distribution Governance

* Review sales journeys, marketing material, and customer disclosures to ensure fairness and regulatory compliance.

* Monitor intermediary conduct including agents, brokers, web aggregators, POSP channels, TPAs and corporate agents.

* Identify and investigate potential instances of:

* Mis-selling

* Unfair trade practices

* Fraudulent sales activity

* Inadequate disclosures

* Customer detriment

Training & Culture

* Conduct employee and Sales training programs on:

* IRDAI regulations

* Customer protection norms

* Ethical sales practices

* Conduct risk awareness

* Anti-mis-selling standards

* Support development of a strong compliance and customer-first culture across the organization.

Educational Qualification

* Bachelors degree in Law, Commerce, Finance, Management, Insurance or related discipline.

* Professional qualifications such as LL.B., CA, CS, MBA, PGDM, CPCU, III certification or compliance/risk certifications shall be preferred.

Experience

* 1012 years of relevant experience in:

* Insurance compliance

* Market conduct

* Risk management

* Internal audit

* Regulatory affairs

* Consumer protection

* Health insurance operations

* Prior experience in health insurance, general insurance, TPA or insurance consulting preferred.

Required Skills & Competencies

* Strong understanding of IRDAI regulations and insurance industry practices.

* Knowledge of health insurance products, underwriting and claims processes.

* Familiarity with conduct risk frameworks and governance mechanisms.

* Solid analytical, investigation and reporting capabilities.

* Excellent drafting and stakeholder management skills.

* Ability to interpret regulations and provide practical implementation guidance.

* High ethical standards and attention to detail.

* Proficiency in MS Office, MIS reporting and compliance monitoring tools.

📌 Lead Market Conduct & Fraud Risk Management (Mumbai)
🏢 Prudential Technology And Services
📍 Mumbai