Role & responsibilities

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TP Claims Quality Control
- Conduct quality audits and reviews of Motor Third-Party (TP) claims files and investigation reports across locations.
- Assess compliance with regulatory guidelines, internal claims procedures, and fraud risk management policies.
- Evaluate claim handling quality and identify deviations, gaps, and potential leakages.
- Ensure consistency in claim assessment and settlement practices across the organization.

Fraud Risk Management
- Identify suspicious claim patterns, fraud indicators, and potential red flags in TP claims.
- Conduct root cause analysis of fraudulent or high-risk claims.
- Work closely with claims, legal, underwriting, and investigation teams to strengthen fraud controls.
- Support fraud detection initiatives and recommend preventive measures to mitigate risks.

Data Analytics & Audit
- Perform regular claims data audits and trend analysis to identify anomalies and risk areas.




- Generate MIS reports, dashboards, and exception reports for management review.
- Utilize analytical insights to recommend improvements in fraud detection and claims quality.

Investigation & Vendor Monitoring
- Review investigation findings submitted by investigators, advocates, and service providers.
- Monitor performance and quality standards of investigation agencies and vendors.
- Ensure timely closure of observations and implementation of corrective actions.

Process Improvement & Controls
- Recommend enhancements in claims processes, fraud triggers, and quality review mechanisms.
- Participate in the development of control frameworks to improve claim governance.
- Assist in automation projects and system enhancement initiatives related to TP claims.

Stakeholder Management
- Coordinate with Claims, Legal, Underwriting, Risk Management, Operations, and IT teams.
- Provide feedback, guidance, and

📌 TP Quality Control (Navi Mumbai)
🏢 Universal Sompo General Insurance
📍 Navi Mumbai