Consultant Claims Investigation

18 hours ago


Bengaluru, Karnataka, India Digit Insurance Full time ₹ 5,00,000 - ₹ 15,00,000 per year

Overview

TheClaims Investigator plays a critical role in safeguarding the integrity of lifeinsurance claims by conducting rigorous investigations into potentiallyfraudulent or high-risk cases. The role demands sharp analytical acumen,compliance awareness, and effective coordination with internal teams andexternal agencies. It also includes managing vendors and contributing tocontinuous risk mitigation strategies.

Responsibilities

  • Conduct thorough investigationson flagged life insurance claims for fraud, anomalies, or discrepancies.
  • Review and analyze supportingevidence: medical records, PMRs, FIRs, employment history, and police reports.
  • Collaborate with forensicexperts, legal advisors, and external partners to build a comprehensive case.
  • Prepare detailed investigationreports highlighting findings, recommended actions, and escalation notes.
  • Oversee onboarding ofinvestigation vendors and manage fee processing and records.
  • Monitor investigation KPIs andpublish monthly dashboards on fraud trends, resolution time, and vendorperformance.
  • Suggest updates to claims processing protocolsand preventive fraud controls based on investigation insights.

Requirements

  • 3-5 years experience ininsurance investigations, fraud detection, law enforcement, or financialcompliance.
  • Deep understanding ofinvestigation techniques and insurance fraud regulations.
  • Excellent documentation reviewand information synthesis capabilities.
  • Skilled in interviewing, withhigh integrity and ethical standards.
  • Proficiency in investigationtools, MS Office, and basic database querying.
  • Capable of managing multiple cases with tightdeadlines.


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