Circle Head-ILM-Network Audit [Health & EW]
Bajaj Allianz General Insurance
Date: 15 hours ago
City: Kolkata, West Bengal
Contract type: Full time
- PRINCIPAL ACCOUNTABILITIES
- Planning and Preparation:
- Establish an audit team with appropriate expertise and qualifications.
- Review relevant regulations, guidelines, and company policies related to network empanelment.
- Develop an audit plan, including the scope, objectives, timelines, and resource allocation.
- Communicate the audit plan to relevant stakeholders and obtain necessary approvals.
- Assessment of Existing Processes:
- Evaluate the existing network empanelment policies and procedures.
- Review the criteria and process for the selection, onboarding, and monitoring of third-party service providers.
- Assess the due diligence and background checks conducted on service providers.
- Verify compliance with regulatory requirements and industry best practices.
- Sampling and Testing:
- Select a representative sample of third-party service providers for testing.
- Review the documentation and records related to the empanelment of the selected service providers.
- Conduct on-site visits or virtual assessments, as applicable, to validate the information provided.
- Test the effectiveness of controls and processes related to network empanelment.
- Reporting and Recommendations:
- Document the findings, observations, and areas for improvement in a comprehensive audit report.
- Classify the findings based on their severity and impact.
- Provide recommendations for addressing identified gaps and enhancing the network empanelment
- Present the audit report to relevant stakeholders and management for review and discussion.
- MAJOR CHALLENGES
- Working in a noncooperative and resistive environment may be stressful.
- Experienced Network auditors with blend of investigative and analytical thinking are rare
- Knowledge of General insurance industry is limited
- Rural reach, extensive travelling, facing hostile situations
- Handling data from multiple sources. Most of these sources use unique data collection methods and formats
- DECISIONS
- Shortlisting vendors (Auditors) and Financials payouts
- Strategic planning & execution to deliver the maximum output from available resources / manpower.
- Recommendation with regards to process enhancement & Implementation
- Recommendations to the VH’s on the new opportunities to investigate and prevent frauds / leakages.
- INTERACTIONS
Roles you need to interact with inside the organization to enable success in your day to day work
- Head of Analytics
- Head ILM, VH & ILM team members
- Claim’s, Underwriting, Business, Actuarial, Risk, Audit, HR, Legal, EW etc
Roles you need to interact with outside the organization to enable success in your day to day work
- Data Analytics Vendors
- Private detective agencies
- Field Investigation/Agency
- Audit Firms
- Business process improvement solutions (Leakage / Fraud proof )
- Use of analytics towards Fraud Risk assessment
- MBBS / BE in Electronics/Mechanical/automobile/Electricals
- Professional education in Fraud / Forensic studies / Law / Risk management / Audit
- Knowledge of – Audit, Data analysis, Fraud Risk Management,
- A minimum of 10 Years of work experience. (with at least 5 years of Fraud risk experience)
- Interview skills, Content writing skills, Team management skills
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