Role & responsibilities

Motor OD Claims Investigation & Quality Control

- Monitor and review Pan India Motor OD claims investigations to ensure quality, consistency, and compliance with company guidelines.
- Analyze investigation reports and recommend corrective actions for process improvement.
- Ensure adherence to established investigation and fraud control protocols.

Risk Assessment & Fraud Control

- Identify, analyze, and assess risks associated with Motor OD claims.
- Detect suspicious claim patterns and potential fraud indicators.
- Develop and implement fraud prevention strategies to minimize claim leakages and financial losses.
- Support risk management initiatives and loss minimization programs.

Trigger Management & Process Enhancement

- Coordinate with Claims, Underwriting, Investigation, and other internal stakeholders to review existing claim investigation triggers.
- Recommend and implement recent triggers based on emerging fraud trends, claims experience, and operational insights.
- Continuously improve fraud detection frameworks and control mechanisms.

Data Analysis & Auditing

- Conduct data audits to identify anomalies, trends, and exceptions in claims data.
- Collaborate with Data Analytics teams to derive actionable insights for risk mitigation.
- Prepare MIS reports, dashboards, and analytical presentations for management review.





System Development & UAT

- Work closely with IT teams for system enhancements, automation initiatives, and process improvements.
- Prepare business requirements for technology solutions.
- Perform User Acceptance Testing (UAT) and ensure successful implementation of system changes.

Vendor Management

- Build and maintain effective relationships with investigators, surveyors, and other external partners.
- Monitor vendor performance and service quality.
- Ensure adherence to company standards and SLAs.

Team Coordination & Leadership

- Guide and support investigation teams on quality standards and fraud management practices.
- Encourage collaboration and knowledge sharing across teams.
- Drive a culture of accountability, continuous improvement, and operational excellence.

Problem Solving & Decision Support

- Investigate complex claims scenarios and recommend suitable resolutions.
- Provide analytical support for high-risk and suspicious claim cases.
- Contribute to strategic initiatives related to claims efficiency and fraud management.

Preferred candidate profile

Qualifications

- Graduation/Post Graduation
- Certifications in Insurance, Risk Management, Fraud Investigation, or Analytics will be an added advantage.

📌 Central Coordinator (Motor Own Damage Claims) (Navi Mumbai)
🏢 Universal Sompo General Insurance
📍 Navi Mumbai