FCU Analyst

Department: Fraud Control Unit (FCU)
Function: Fraud Risk & Investigation
Experience: 1-5 Years
Location: Gurgaon
Working: 6 Days Working

Role Overview

We are looking for an FCU Analyst / Fraud Investigator to identify, investigate and prevent fraudulent activities across insurance policies and claims. The role will involve analysing customer, policy and claims data, identifying fraud indicators, conducting investigations and coordinating with internal stakeholders to ensure timely and accurate case closure.

Key Responsibilities

• Conduct detailed investigation of suspected fraudulent insurance claims, policies and transactions.
• Analyse customer, policy, claims and transaction information to identify fraud patterns, anomalies and risk indicators.
• Review claim documents, policy details, customer declarations, hospital/garage/vendor records and other supporting information.
• Conduct telephonic and field-level verification wherever required to validate the authenticity of claims and customer information.
• Identify cases involving misrepresentation, document manipulation, duplicate claims, staged incidents, inflated claims, fake documentation or suspicious customer/agent activity.
• Perform background checks and cross-verification of information received from customers, intermediaries, hospitals, garages and other external parties.
• Prepare detailed investigation reports with findings, evidence, risk assessment and recommendations.
• Coordinate with Claims, Underwriting, Operations, Legal, Compliance and Business teams for investigation and resolution of cases.
• Maintain accurate records of investigations, evidence, observations and case outcomes.
• Track investigation TAT and ensure cases are closed within defined timelines.
• Identify recurring fraud trends and provide insights to strengthen fraud prevention and control mechanisms.
• Support development of fraud indicators, risk triggers and investigation checklists.
• Escalate high-risk or complex cases to senior management as per defined protocols.
• Maintain confidentiality of customer and investigation-related information.

Key Fraud Areas

The candidate should be comfortable investigating cases related to:

• Fake or manipulated documents
• Misrepresentation of customer/policy information
• Duplicate or multiple claims
• Inflated claims
• Staged or fabricated incidents
• Suspicious hospitalization/medical claims
• Motor accident/vehicle-related fraud
• Identity-related fraud
• Agent/intermediary fraud
• Policy issuance-related irregularities
• Suspicious patterns across customers, hospitals, garages or vendors

Required Skills

• Strong analytical and investigative skills.
• Good understanding of insurance processes, preferably Claims / Underwriting / Operations / Fraud Investigation.
• Strong attention to detail and ability to identify inconsistencies.
• Good communication and questioning skills for customer/intermediary verification.
• Ability to analyse large volumes of information and connect multiple data points.
• Strong report-writing and documentation skills.
• Proficiency in MS Excel; knowledge of MIS/BI tools is an added advantage.
• Ability to work with sensitive and confidential information.
• Strong decision-making, problem-solving and stakeholder-management skills.

Qualification & Experience

• Graduate in any discipline; candidates with backgrounds in Insurance, Finance, Risk, Law, Investigation or related fields will be preferred.
• 1-5 years of relevant experience in FCU, Fraud Investigation, Insurance Claims, Risk, Audit, Verification or related functions.
• Experience in General Insurance / Health Insurance / Motor Insurance will be preferred.
• Candidates with field investigation or verification experience will be an added advantage.

Key KRAs / KPIs

• Investigation TAT and case closure
• Fraud identification and detection rate
• Quality and accuracy of investigation reports
• Recovery / fraud prevention impact
• Accuracy of evidence and documentation
• Case escalation and resolution
• Identification of new fraud patterns
• Stakeholder turnaround time
• Compliance with investigation SOPs and processes