• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Insurance fraud risk management service
 

Insurance fraud risk management service

on

  • 355 views

 

Statistics

Views

Total Views
355
Views on SlideShare
355
Embed Views
0

Actions

Likes
0
Downloads
0
Comments
0

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Insurance fraud risk management service Insurance fraud risk management service Presentation Transcript

    • 1Fraud Risk Management FrameworkInsurance IndustryRiskpro, India
    • 2About Riskpro
    • 3Background - Who is Riskpro… Why us?ABOUT US Riskpro is an organisation of member firmsaround India devoted to client serviceexcellence. Member firms offer wide rangeof services in the field of risk management. Currently it has offices in three major citiesMumbai, Delhi and Bangalore and alliancesin other cities. Managed by experienced professionals withexperiences spanning various industries.MISSION Provide integrated risk managementconsulting services to mid-large sizedcorporate /financial institutions in India Be the preferred service provider forcomplete Governance, Risk and Compliance(GRC) solutions.VALUE PROPOSITION You get quality advisory, normally deliveredby large consulting firms, at fee levelscharged by independent & small firms High quality deliverables Multi-skilled & multi-disciplined organisation. Timely completion of any task Affordable alternative to large firmsDIFFERENTIATORS Risk Management is our main focus Over 200 years of cumulative experience Hybrid Delivery model Ability to take on large and complex projectsdue to delivery capabilities We Hold hands, not shake hands.
    • 4Riskpro’s Network PresenceNew DelhiMumbaiBangaloreAhmedabadPuneAgraSalemKolkataHyderabadChennaiJaipur
    • 5Risk Management Advisory ServicesTraining RecruitmentBasel II/III Advisory Market Risk Credit Risk Operational Risk ICAAPCorporate Risks Enterprise Risk Assessment Fraud Risk Risk based Internal Audit Operations Risk Forensic servicesInformation Security IS Audit Information Security IT Assurance IT GovernanceOperational Risk Process reviews Policy/ Process Review Process Improvement Compliance RiskGovernance Corporate Governance Business Strategic risk Fraud Risk Forensic AccountingOther Risks Business/Strategic Risk Reputation Risk Outsourcing Risk Contractual Risk Banking – E Learning Corporate Training Regular Risk Management Training Online Training material Workshops / Events Virtual Risk Managers Full Time Risk Professionals Part time Risk Professionals Risk Managers on call – freeSERVICES
    • 6Fraud – Why companies should be concerned? Fraud is increasingly becoming a significant issue for CorporateIndia and insurance companies are also affected. In the E&Y study“India Fraud Indicator 2012” 1, Insurance companies were cited asthe worst hit financial services companies after banks. Another2012 study reported that Indian Insurers lost over Rs 30,000 croredue to frauds in 20112 and that collusion between the employees ofinsurers and private persons, document falsification andmanipulation in citing cause of as some of the more commonreasons behind these frauds. In another E&Y survey in 2010-113, 40% of respondents reportedthat fraud incidents are on the rise and that claim/surrender andpremium related frauds accounted for almost half of fraud riskexposure. The survey also noted with concern that nearly 40% ofinsurers did not have a dedicated anti-fraud departments.1 “India Fraud Indicator 2012” A study by Ernst & Young India2 “Insurers lost over Rs 30k crore due to frauds in 2011, says study” Economic Times Mar 4, 20123 “Fraud in insurance on rise” Survey 2010–11 by Ernst & Young India“Mumbai: Four held for duping widow ofhusbands life insurance money” Mid-Day Jan 242012“Four sentenced to jail terms for clearing bogusinsurance claim” Zee News Dec14th 2012
    • 7Regulator’s View IRDA in January 2013 came out with guidelines onInsurance Fraud Monitoring Framework. The guidelines requires insurance companies & reinsurersto come up with policy, process and procedures to assess,identify, monitor, and mitigate fraud risks and investigate &close fraud reports. This covers all policyholder, intermediaries & internalfrauds. The compliance reports are due to be filed by 30th June2013. The stipulations on fraud detection, classification,monitoring and reporting is effective from Financial Year2013-14
    • 8Avenues for FraudsPolicyholderIntermediariesEmployeesFraudConsequence•Monetary Loss•Reputation•Lost business•Regulatoryactions
    • 9Fraud Risk Management FrameworkFraud RiskAssessmentAnti-FraudProceduresFraudInvestigationsAnti-FraudCultureAnti-FraudGovernanceRespond
    • 10Anti Fraud Program10Governance•Risk Management Committee•Fraud Policy•Monitoring Reports•Due Diligence on•Staff & IntermediariesFraud Response• Internal & externalreporting• Fraud InvestigationManual• Coordination withauthoritiesFraud Assessment• Identifying potential fraudin products & processes• Control Gap analysis• Antifraud manual &procedures• Fraud monitoringFraud Risk ManagementProgramFraud Awareness• Staff training,induction raining &refresher• Fraud manual &SOPs• Reporting process• Whistle-blower policy
    • 11Key Stipulations from IRDA’s CircularGovernance Risk Management Committee Board Approved Fraud Policy Responsibilities & accountabilities for fraud prevention, detection & response Due diligence of staff and intermediaries for fraud risk Independent review of anti-fraud systems & procedures Management, Board & Compliance reportsFraud Risk Assessment Identification of potential areas & departments for fraud threat Review of processes & products for fraud vulnerabilities Gap assessment between desired controls & actual controls Department-wise Anti-fraud procedures for prevention, identification andmitigation of frauds Red flags for fraud monitoring
    • 12Fraud Response and AwarenessFraud Response Internal & external fraud reporting Fraud investigation manual Legal process for any crimes under CRPC Coordination with law enforcementFraud Awareness Staff training, induction raining & refresher Fraud manuals & SOPs Clear process of internal & external fraud reporting Whistle blower policy & procedure Awareness to intermediaries & policyholders
    • 13RiskPro ApproachFraud RiskIdentificationFraudPrevention/DetectionFraudReporting• Identify fraud scenarios& factors for productsand processes• Assess likelihood ofoccurrence andresultant impact on theorganization• Fraud policy with clearaccountabilities &fraud response• Fraud Manual & SOPs• Whistle-blower policy• Anti Fraud Manual• Continuous monitoringof fraud via indicators• Awareness training• Define reporting processfor internal & externalreporting• Define coordinatedapproach forInvestigation &corrective actionsOther Policies such as HR Disciplinary policy
    • 14RiskPro’s OfferingArea Objective RiskPro Service OfferingFraud RiskAssessmentTo identify the organization’s susceptibilityto specific types of fraud and thelikelihood and significance of those frauds Identify fraud scenarios &factors for products andprocesses Assess likelihood ofoccurrence and resultantimpact on the organizationControl gapAssessmentTo assess effectiveness of anti-fraudcontrols and implement or improvecontrol measures to appropriately manageidentified fraud risks Test existing controls Identify control gaps Recommend controlenhancementsAnti-FraudProceduresTo enable an organization to structureIts operating policies & procedures so thatfraud will be detected if it occurs, andascertain that its anti-fraud policies andprocedures are well constructed, properlycommunicated and followed Fraud policy with clearaccountabilities & fraudresponse Fraud Manual & SOPs Whistle-blower policy Fraud Monitoring ReportsFraud AwarenessTrainingTo enable an organization’s employees,officers, directors and agents to identifyand respond appropriately to the signs offraud Awareness & specialisedanti-fraud training withhands-on case studies tostaff and intermediaries
    • 15Riskpro Clients Our Clients*Any trademarks or logos used throughout this presentation are the property of their respective ownersBanking/InsuranceCorporateMNCBankingIntlConsultingIT / Others
    • 16Team Experiences Our ExperiencesOur team members have worked at world class Companies*Any trademarks or logos used throughout this presentation are the property of their respective owners
    • 17RESUMES – Our team Co-Founder - Riskpro CA, CPA, MBA-Finance (USA), FRM (GARP) Over 10 years international experience – 6 years in Bahrain and 4 years USA 15 years exp in risk management consulting and internal audits, Specialization inOperational Risk, Basel II, Sox and Control design Worked for Ernst & Young (Bahrain), Arab Investment Company (Bahrain),Navigant Consulting(USA), Kotak Mahindra Bank (India) and Credit Suisse(India) Sox Compliance project for Fannie Mae, USA ( $900+ Billion Mortgage Company)ManojJain Co- Founder - Riskpro CA (India), MBA (Netherlands), CIA (USA) Over 15 years of extensive internal and external audit experience in India andabroad. Worked with KPMG United Arab Emirates, PKF South Africa, Ernst and YoungKuwait, Deloitte Netherlands and KPMG India. Worked with clients in a wide variety of industries and countries including trading,retail and consumer goods, NGO, manufacturing and banking and finance. Majorclients include banks, investment companies, manufacturing organizations,aviation etc.RahulBhanCredentials
    • 18RESUMES - Our team Co-Founder - Riskpro PGD (Electrical & Electronics & Computer Programming) 30 years of experience in Information & Communications Technology (ICT) Solutionsfor Retail, Garments, Manufacturing, Services Industries. Has created Companies, Divisions, Products, Brands, Teams & Markets. Consulting in Business, Technology, Marketing & Sales & Strategic Planning. Advisory, Training, Workshops & Implementation in Systems Thinking, SystemsModeling & Balanced Scorecard Worked with TIFR, Mahindra, Ambience, Communico-Graphique & Ionidea Inc, USA,CasperAbrahamCredentials Sr Vice President – Risk Management MBA, PDFM,NSE-NCFM, PMP, CSSGB,ISO 9001:2000 I.A,GARP-FBR, ITILV3,CPP-BPM Professional with 17 years of rich experience into diverse Consumer finance/ Lendingoperations ,Risk Management,BPMS, Consumer Banking, NBFC, Management Consulting &Housing finance in BFSI industry having successfully led key business strategicengagements across multi-product environment in APAC, Australia and US regions. Worked with GE, ABN AMRO Bank, Citigroup, Accenture, Deutsche Postbank Highly skilled and expert Trainer in Risk areas across Credit, Fraud, Operational, CorporateRisk management. Specializes in Fraud Control, AML/KYC Compliance ,QA ,ERM and Regulatory governance.HemantSeigell
    • 19RESUMES - Our team Head - Insurance Risk Advisory services B.sc, Associate of Indian Institute of Insurance Licensed Category A Insurance surveyor 26 years of experience in Insurance advisory services, Loss adjusting for largecorporates,Claims management. Has assessed more than 4500 high value insurance claims across various industrysectors. Risk management inspection Valuations of fixed assets for insurance purpose.R.GuptaCredentials Head - Human Capital Management Chartered Accountant, Lead Assessor ISO 9000, Six Sigma Trained, Trained on SituationalLeadership, Trained on interviewing skills and Whole Message Model. Over two decades of international, multi-cultural experience in finance and human resourcesviz. internal audit, accounting operations, accounting process review & re-designing, riskmanagement, business solutioning, six sigma projects, talent acquisition, talent retention,organization design/redesigning, compensation and appraisal processing, employee andcustomer satisfaction surveys, knowledge management and finance services. Worked with Citicorp/MGF, India Glycol, Delphi, American Express India, American ExpressUSA, Fidelity International and Macquarie Global Finance Services India.NileshBhatia
    • 20RESUMES - Our team Head – Taxation Risk Advisory B.Com, FCA Senior Partner with 48 year old Delhi based Chartered Accountant firm, Mehrotraand Mehrotra Over 19 years of experience in the field of Audit, Taxation, Company law matters. Major clients served are NTPC, BHEL, Bank of India, PNB, Airport Authority ofIndia etc.RajeshJhalaniCredentialsPresident – Banking & Financial Services A senior researcher in Applied Mathematics leading to Ph.D after MSc (Mathematics),CWA, CAIIB Combined experience of 25+ years in corporate banking, risk management,international trade finance, development of risk rating models, project finance, creditmonitoring and NPA management Since 2006 conducting open / in-house training on the above domains to all Toppublic/ new and old private sector banks, top MNC banks (India and abroad), leadingNBFCs and corporates in manufacturing and financial services space; Worked on IFC(World Bank) funded projects for MSMEs in India and abroad Worked for Bank of Baroda and ICICI Bank – bestowed Top Performer Awardcontinuously two years during his tenure; widely travelled abroad for businessrelations, seminars, offering training, investor meetings, NYSE listing and forprocesses involving establishment of representative Office in USASivaramakrishnan
    • 21Executive Vice President – Risk Management ( Banking & Financial Services) A hands-on banking professional {BSc (Mathematics), CAIIB} with considerabledomestic and international experience An aggregate experience of 24+ years across industry, mainly BFSI in severalfunctional areas including Retail and Commercial Banking, Corporate Lending, teammember of the Business Process Re-Engineering project (BPR); conceptualizing andsetting up shared services centres for centralized operations for the Bank in India. Management through ERM framework overseeing all key areas of the businessthrough various Operational Risk tools like KRI / RCSA matrices. Managing of majorproject implementation of Basel II and Compliance risk framework Directing, reviewing and advising Board of Directors on various compliance issues andrepresenting the bank to the Central Bank regulatory offices. Worked for ANZ Grindlays Bank, Standard Chartered, Bahraini Saudi Bank and DubaiHoldings ( subsidiary)KashiBanerjeeRESUMES - Our team CredentialsConsultant – Information Security & IT Governance LLB, CA, CISA, CWA, CS, CFE and others Over 15 years of experience in the field of Audit, Taxation, Investigations. Specializing in the field of Systems Audit, Cybrex Audit, Computer CrimeInvestigations, IS Forensics International Committee Member of Governmental and Regulatory AgenciesBoard and Academic Relations Committee of ISACA, USAAnjayAgarwal
    • 22Executive Vice President – Risk Management ( Banking & Financial Services) Professional Risk Manager with considerable domestic and international experience An aggregate experience of 30 + years across industry, mainly Banking in several functional areasincluding Wholesale Credit Risk, Operational Risk, Trade Finance , Retail Banking and Islamic FinancialServices. Track record of setting up of excellence in the set-up, and management of credit and operational risk,compliance and credit administration functions in retail, commercial , Islamic Banking and offshore bankingentities in the Middle East. Key strength includes Corporate Credits, Risk Management in IT, implementation of Risk Managementmodule in core banking Bank’s Policies, procedures, Country Risk. Played an active role in 3 core bankingsoftware implementations Worked for a Private Sector Bank in India, ABN AMRO Bank, Bahrain, Bank Muscat Bahrain and BMI BankBahrain as AGM Risk Management.VijayanGovindarajanRESUMES - Our team Credentials Specialist Risk Consultant – ERP & IT Compliance SAP Certified, MBA (Finance), SAP Security trained (from SAP India), SAP GRC Access Controls trained(from SAP India) Over 7 years of experience working in the area of ERP/IT Risk advisory, primarily focusing on SAP, for‘Fortune 500’ clients in around 8 countries including US, UK, UAE, Hong Kong, etc Specializes in SAP Risk & Controls Advisory, SAP Business Process Controls Audit, SAP Security &Segregation of Duties Control Audit, ERP Trainings, Strong Industry experiences ranging from Beverages, Insurance, Energy, FMCG, Pharmaceutical, Retail,Telecommunication to IT Services Worked for risk advisory teams of reputed organizations like Ernst & Young, EXL ServicesGouravLadha
    • 23RESUMES - Our team Credentials Vice President – IT Risk Advisory Over 14+ Years of Experience in Information Security and Risk Management & CISMcertified Headed the Global Information Security team of Daimler (Mercedes-Benz) Worldwide atBangalore for 9 years, previously worked at organization like Wipro, Bangalore Labs Multi-sector experience including Banking, Insurance, Finance, Energy, Manufacturing,Retail, Hi-Tech & Telecom, and Automobile Well known Ethical hacker: Was featured in BusinessWorld Magazine in an article aboutleading ethical hackers in India and published several articles in Print and Online Media Rich experience in Information Security Audits across Corporations, 3rd Party Suppliers, JointVentures across several countries in the world including US, UK, China, GermanyAashishSrivastavaRavikiranBhandari Specialist Consultant – Legal Risk Advisory B.B.A. ,LL.B. (Hons.) About half a decade experience in legal services to client’s with respect to Contractand Commercial Laws, Joint Ventures, Inbound & Outbound Investments, PrivateEquity Investment Transactions, Real Estate & Infrastructure, Energy and GeneralCorporate. Have advised various social enterprises and start ups in setting up business inIndia. Worked for the leading law firms of India such as FoxMandal Little.
    • 24RESUMES - Our team CredentialsPhanindraPrakash Vice President – Riskpro India FCA [India], ACMA [India], CFE [USA], CertIFRS [UK] Over 16 years of extensive consulting experience which includes financial & systems audit,process transformation, implementation of internal controls, SOX compliance, fraud audits& due diligence, US-India taxation Engaged in consulting roles as trusted advisor to finance, internal audit and informationtechnology executives of multiple Fortune 1000 companies with project sites in US,Canada, Europe & Asia Worked with E&Y and Deloitte Consulting in USA Some of the major clients served internationally are GE Capital, UBS, McKesson, Eaton,Imation, Albertsons, EVP and Head – Telecom Risk Advisory M.Tech (IIT Kharagpur),IES,Doctoral study, research and teaching in LinkopingUniversity/Sweden, Lead Auditor (BVQI). Over 30 years of International experience in networks and mobile Handsets from top globalcompanies /institutes like ISRO, Ericsson, Nokia, Nokia Siemens Networks based in itshead quarter locations in India, EU, USA. Expertise: Setting up capability, behaviour, culture in turning Risk, Quality, Innovation forcompetitive advantage, customer delight and sustainability; key skill sets are Engagement,Handholding, Coaching, Mentoring and lot of best practices, benchmarking/standards likeCMMI, TL9000, Six Sigma, ISO, SAS 70 etc.AsokSit
    • 25RESUMES - Our team CredentialsSiddharthaGhosh Executive Vice President – Riskpro India CPA (USA), ACA, ACS, Grad CWA (India), MBA (USA), Associate ICPAS (Singapore) Over 25 years of extensive audit and industry experience which includes 19 years withRolls-Royce India Pvt Ltd at New Delhi and its associate and parent companies of Rolls-Royce in UK, USA and Singapore in all aspects of Finance, Taxation, Audit, Banking, Legal,Company Secretarial, Statutory compliances and due diligence, Internal Control, ESOP,Budgets, Cashflows, Forecasts, MIS Reporting, HR, Expatriate & Office Administration,Payroll, IT, Retirement Funds Administration, Shared Services, Project Accounts, etc. Worked with Price Waterhouse Coopers for 4 years with reputed MNCs, banks, Indiancorporate houses Worked with McNally Bharat Engineering Company Ltd for 4 yearsPritiTawari Vice President – Riskpro India B. Com, ACA, Dip. IFRS Over 6 years of extensive audit and industry experience in all aspects of Finance, Taxation,Audit, Legal, Company Secretarial, Statutory compliances and due diligence, InternalControl, Budgets, Cash flows, Forecasts, MIS Reporting, HR, Expatriate & OfficeAdministration, Payroll, IT, Project Accounts, etc. Worked with Price Waterhouse Coopers for 3 years in audit & assurance for reputedMNCs, Indian corporate houses. Engage in own practice since 2010 specialize in outsourcing of finance department in midsize MNCs and consultation in Indirect Taxes and Management Reporting
    • 26RESUMES - Our team CredentialsManojKumarSenior Vice PresidentCAIIB20 Years of hard core banking experience in India’s most reputed banksacross wide functional areas.Worked with Central Bank of India, ICICI Bank, HDFC Bank, and AxisBank as Asst Vice President, Cluster Head, and Branch Head.Areas of expertise are Financial Risk Management, NPA-Credit-DebtManagement, Asset Reconstruction, Project Finance, and others.Accomplished several achievements in the functional areas of banking.
    • 27 Specialist Risk Consultant – Business Continuity Founder and 15-year Chairman of Survive, the first international user group for BusinessContinuity professionals Founding director and first Fellow of the Business Continuity Institute Over 25 years international consulting expertise in Risk, Crisis, Emergency, Incident, andBusiness Continuity and ICT Disaster Recovery Management Multi-sector experience including Banking, Insurance, Finance, Oil, Gas, Energy,Manufacturing, Retail, Hi-Tech & Telecom Western Press Award for services to business, 1994; BCI/CIR nomination forlifetime achievement in BC, 1999, London; inducted into BC Hall of Fame by CPM magazine,2004, Washington DC.AndrewHilesRESUMES - PARTNERSHIPS Specialist Risk Consultant – Enterprise Risk Management Highly skilled risk and insurance professional with 25 years of experience designing, developing andimplementing large, global corporate risk management programs for Fortune 500 firms. Principal Consultant and Founder - Excellence in Risk Management, LLC. (Texas, USA) Co-founder andEVP, Professional Services, rPM3 Solutions, LLC (Maryland, USA). Past experiences include Head of Global Risk Management for USAA, PepsiCo/Tricon Global and AmericanNational Red Cross Additional risk and insurance experience at Verizon Corp,. Marsh USA and Liberty Mutual Insurance Co. 2004 Risk Manager of the Year – 2007 recipient of the Alexander Hamilton Award for “Excellence in ERM” (atUSAA) – former President, Risk and Insurance Management Society, Inc.ChrisE.Mandel
    • 28Key ContactsCorporate Mumbai Delhi BangaloreRiskpro India Ventures (P)Limitedinfo@riskpro.inwww.riskpro.inF 186, Sarita ViharNew Delhi 110076Manoj JainDirectorM- 98337 67114manoj.jain@riskpro.inShriram GokteEVP - Risk ManagementM- 98209 94063shriram.gokte@riskpro.inSivaramakrishnanPresident – Banking & FSM- 98690 19311smaran.iyer@riskpro.inRahul BhanDirectorM- 99680 05042rahul.bhan@riskpro.inHemant SeigellSVP – Risk ManagementM- 99536 97905hemant.seigell@riskpro.inCasper AbrahamDirectorM- 98450 61870casper.abraham@riskpro.inVijayan GovindarajanEVP – Risk ManagementM- 99166 63652vijayan.govindarajan@riskpro.inRavikiran Bhandari VP – ITRisk AdvisoryM- 99001 69562ravikiran.bhandari@riskpro.inGhaziabad / Noida Chennai Kolkata GurgaonSiddhartha GhoshEVP - FinanceM- 9810058072Siddhartha.Ghosh@riskpro.inR Gupta - Insurance RiskM- 98101 07387R. MuralidharanEVP – Risk ManagementM- 95660 77326murali@riskpro.inKashi BanerjeeEVP – Risk ManagementM- 98304 75375kashi.banerjee@riskpro.inNilesh BhatiaHead – Human Capital Mgt.M- 98182 93434nilesh.bhatia@riskpro.inAsok SitEVP – Telecom Risk AdvisoryM- 98105 03463asok.sit@riskpro.inPune Salem Ahmedabad Hyderabad / AgraM.L. JainPrincipal – Strategy RiskM- 98220 11987mljain@riskpro.inPriti TawariM- 9011054085ChandrasekeranRecruitment franchiseeM – 94435 99132Manoj KumarM – 98983 65320Maulik ManakiwalaM – 98256 40046Gourav LadhaPhanindra Prakash (Hyderabad)Member FirmM- 95500 61616Alok Kumar Agarwal (Agra)Member FirmM- 99971 65253