TP Quality Control - Fraud Risk Management

Universal Sompo General Insurance; Navi Mumbai; On-site; INR 600,000 - 900,000; Full time

Job summary

Universal Sompo General Insurance in Navi Mumbai seeks a TP Claims Quality Control professional to conduct quality audits of Motor TP claims, assess compliance with guidelines, and ensure consistency across locations.

The role includes fraud risk management, data analytics, investigation review, vendor monitoring, and driving process improvements with cross-functional teams; graduate or postgraduate with general insurance background preferred.

Qualifications

• Graduate or postgraduate with general insurance background preferred.
• Experience in TP (Third Party) claims quality and fraud risk policies is desirable.
• Ability to coordinate with multiple internal teams and external partners.

Responsibilities

• Conduct quality audits of Motor TP claims files and investigation reports across locations.
• Assess compliance with regulatory guidelines, internal procedures, and fraud risk policies.
• Perform data analytics, trend analysis, and generate MIS dashboards for management review.
• Review investigation findings and monitor vendor performance to ensure timely closure of observations.
• Suggest process improvements and contribute to control frameworks for claims governance.

Skills

Quality audits

Fraud detection

Data analysis

MIS reporting

Stakeholder management

Education

Graduate

Postgraduate

Job description

Role & responsibilities

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 training to claims teams on quality standards and fraud prevention practices.
• Support management with risk assessments and strategic recommendations.

Preferred candidate profile

• Graduate/Post Graduate
• Candidate from General Insurance will be preferred