Manager - FCU

Care Health Insurance; Gurugram District; On-site; INR 700,000 - 1,000,000; Full time

Job summary

Care Health Insurance is seeking a qualified legal/compliance professional to conduct investigations into fraud and policy violations. You will gather and analyse evidence, prepare professional reports with recommendations, and liaise with police, government, and external authorities.

You will draft notices and replies to legal proceedings as required. The role requires a Law degree or higher, strong analytical skills, and willingness to work from the office, with travel if needed.

Qualifications

• Graduate or higher; Law graduates preferred.
• Basic knowledge of Microsoft Office.
• Strong analytical, logical and problem-solving skills.
• Willingness to work from office and travel if required.
• Good communication skills.

Responsibilities

• Conduct investigations into fraud, mis-selling, waste or abuse, misconduct and policy violations.
• Gather, review and analyse evidence to identify root causes and prepare reports with recommendations.
• Draft police complaints and liaise with Police, Government and external authorities.
• Draft show cause and recovery notices in cases of fraud.
• Draft replies to police notices, court orders and other legal notices.

Skills

Analytical thinking

Communication skills

Legal knowledge

Attention to detail

Travel willingness

Education

Law degree

Graduate

Tools

Microsoft Office

Job description

Role & responsibilities

1. Conducting investigations and inquiry into allegations of fraud, mis-selling, waste

or abuse, misconduct and policy violations.

2. Gather, collate, review and research evidence/documents to analyse the overall fact

pattern of complaint related to fraud to identify the root causes and prepare

professional reports with justified recommendations and opinion. Also undertake

other assignments within the legal and compliance function as required.

3. Drafting police complaints and representing the company before the police/

government/external authority. Liasoning with Police, Government and external

authority in company related matters.

4. Drafting show cause notice, recovery notice against the intermediary, employee,

hospital, customer, etc in case of fraud.

5. Drafting replies to Police Notice, Court Orders, Legal Notices, etc. received at the

company end.

Measures of Success for the Role

• Timely closure of Investigation of complaints.
• Giving sound opinion and resolution in complaint investigation.
• Report writing/presentation to the committee/conducting trainings.
• Successful liasioning with external authorities
• Successful drafting and filing of complaint with external authorities
• Successful drafting Show Cause Notice, recovery notice in cases of fraud and misselling.

Required Qualification and Experience

• Graduate & above (Law Graduate preferred)
• Basic knowledge of Microsoft Office Suite
• Excellent in analytical, logics and problem solving skills.
• Should be comfortable to work from office
• Should be comfortable to travel for work if required
• Should have good communication skills