Fraud & Investigation - Compliance

Job description

Job Description A Position Overview Position Title Department Band Assistant Manager Compliance Fraud Monitoring Unit 301 B Organizational Relationships Reports to Direct Associate Vice President Fraud Monitoring Unit Supervises Investigations, Data Analytics, Central Co-ordination Reporting & C Job Dimensions Geographic Area Covered PAN India Stakeholders Internal Operations (All teams), Front Line sales employees, Agents, Audit, Regulatory Compliance, Risk Management Office, Finance and Accounts Stakeholders External Customers, Vendors, Field Investigators, AIA Group D Key Result Areas Investigations & Case Management Conduct investigations related to sales misconduct, customer complaints, early claims, and other sourcing malpractice including fraud, mis-selling, document forgery, and non-disclosure, Whistleblower complaints including internal frauds. ¢ Handle employee and agent-related investigations across pre-issuance, post-issuance, and claims stages. Conduct interviews with employees, agents, and relevant stakeholders, ensuring professional, unbiased, and defensible fact-finding. ¢ ¢ Analyze policy-level data, submission patterns, persistency trends, cancellation ratios, and claim linkages to establish employee / agent accountability or collusion Support investigations involving suspected nexus fraud between employees, agents, vendors, or external parties. Data Analysis & Control Assessment ¢ Conduct in-depth data analysis using Excel, dashboards, or analytics tools to identify trends, outliers, and red flags. ¢ ¢ Identify process weaknesses and control gaps leading to misconduct or fraud. Work with stakeholders in developing a root-cause analysis and recommend/agree on suitable corrective and preventive measures. Stakeholder Coordination ¢ Coordinate with Claims, Underwriting, Sales, HR, Legal, Risk, and Operations teams for investigation inputs and case closure. ¢ ¢ Follow up on end-to-end closure of cases, including disciplinary actions, process fixes, or policy changes. Support internal and external audits, regulatory reviews, and management reporting related to fraud and market conduct cases. Documentation & Reporting ¢ Prepare clear, structured investigation reports with evidence, observations, conclusions, and recommendations. ¢ ¢ ¢ Maintain accurate case records aligned to internal governance standards and regulatory expectations. Track case metrics, aging, and outcomes for periodic MIS and dashboards. Assist in special projects related to process reviews, regulatory preparedness, control testing, or thematic conduct risk assessments. Project Management ¢ ¢ Translate investigation outcomes and analytics into actionable insights, recommending corrective and preventive measures including process changes, control enhancements, and targeted interventions. Partner with Zonal and Regional Sales Leadership to Building Ethical Culture reinforce ethical selling practices, fair customer outcomes, and adherence to company policies and regulatory expectations. ¢ Drive a culture of ethical conduct and joint accountability, enabling business leaders to own conduct risks alongside Compliance and Market Conduct teams. E Skills Required Excellent Knowledge of MS- Excel, Word, Power-Point, Drafting Skills Technical Level 1 OK Level 2 Level 3 Behavioral \\* Interpersonal skills Communication skills Teamwork Skills OK OK Ok Decision making skills Incumbent Characteristics Essential Desired Graduation in any field MBA, CA, LLB Qualification Experience Prior work experience in Audit, Compliance, Risk Management, Anti-Fraud, Risk Knowledge of AML, Infosec Guidelines, Certified Fraud Examiner (CFE) Control Units, Claims Investigations, Service Assurance etc.