insurance fraud risk management service

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Post on 19-May-2015



Economy & Finance

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It gives me immense pleasure to introduce our firm “Riskpro” founded in 2009- a specialized risk management consulting by our Founders who are qualified risk specialists with diverse work experience in India, Middle East, Europe & US across industries & FI’s. In continuation of our fast growing presence and business trajectory, I would like to welcome you and share towards launch of RiskPro Insurance Risk advisory Services which is an addition to our existing bouquet of Risk advisory , Consulting, Training & Human Capital Services to corporates across India currently being serviced through our multi location delivery locations in major metros with total presence in 11 Indian cities network already. Our dedicated experts team who are qualified seasoned professionals in Insurance industry across diverse business domains with right blend of optimal solutions for high performance business results. Insurance business , like any other industry has evolved with new business models, government and regulatory changes, increased market players and de-regulation which has impacted functioning of major insurance players (General, Life)to generate business and also adhere to compliances imposed by governing authorities within volatile global paradigm, which necessitates the need for prudent risk management framework in Insurance businesses. Riskpro with its precise risk-reward approach is your ideal partner in de-risking of your insurance business operating model with risk management value proposition for a long-lasting embedded tenet in your business DNA. Risk Management Service offerings:- - Risk - Evaluation/Inspection/Audit & Reporting - Due-Diligence – Current Insurances/Indemnity advisory/Renewals - Capital Assets Valuation for loss coverage - Claims Management - Regulatory Compliances- IRDA/SEBI/ICDR Key Domain Areas:- - Property Risk- Physical Assets - Financial Risk- Monetary Loss - Liability Risk- Operational Loss - People Risk- Employees Loss Please find enclosed our Company brief introduction and services brochure for your kind consideration and give us a chance to be your preferred risk knowledge partners for a mutual alliance.


  • 1. 1 Fraud Risk Management Framework Insurance Industry Riskpro, India

2. 2 About Riskpro 3. 3 Background - Who is Riskpro Why us? ABOUT US Riskpro is an organisation of member firms around India devoted to client service excellence. Member firms offer wide range of services in the field of risk management. Currently it has offices in three major cities Mumbai, Delhi and Bangalore and alliances in other cities. Managed by experienced professionals with experiences spanning various industries. MISSION Provide integrated risk management consulting services to mid-large sized corporate /financial institutions in India Be the preferred service provider for complete Governance, Risk and Compliance (GRC) solutions. VALUE PROPOSITION You get quality advisory, normally delivered by large consulting firms, at fee levels charged by independent & small firms High quality deliverables Multi-skilled & multi-disciplined organisation. Timely completion of any task Affordable alternative to large firms DIFFERENTIATORS Risk Management is our main focus Over 200 years of cumulative experience Hybrid Delivery model Ability to take on large and complex projects due to delivery capabilities We Hold hands, not shake hands. 4. 4 Riskpros Network Presence New Delhi Mumbai Bangalore Ahmedabad Pune Agra Salem Kolkata Hyderabad Chennai Jaipur 5. 5 Risk Management Advisory Services Training Recruitment Basel II/III Advisory Market Risk Credit Risk Operational Risk ICAAP Corporate Risks Enterprise Risk Assessment Fraud Risk Risk based Internal Audit Operations Risk Forensic services Information Security IS Audit Information Security IT Assurance IT Governance Operational Risk Process reviews Policy/ Process Review Process Improvement Compliance Risk Governance Corporate Governance Business Strategic risk Fraud Risk Forensic Accounting Other 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 free SERVICES 6. 6 Fraud Why companies should be concerned? Fraud is increasingly becoming a significant issue for Corporate India and insurance companies are also affected. In the E&Y study India Fraud Indicator 2012 1, Insurance companies were cited as the worst hit financial services companies after banks. Another 2012 study reported that Indian Insurers lost over Rs 30,000 crore due to frauds in 20112 and that collusion between the employees of insurers and private persons, document falsification and manipulation in citing cause of as some of the more common reasons behind these frauds. In another E&Y survey in 2010-113, 40% of respondents reported that fraud incidents are on the rise and that claim/surrender and premium related frauds accounted for almost half of fraud risk exposure. The survey also noted with concern that nearly 40% of insurers did not have a dedicated anti-fraud departments. 1 India Fraud Indicator 2012 A study by Ernst & Young India 2 Insurers lost over Rs 30k crore due to frauds in 2011, says study Economic Times Mar 4, 2012 3 Fraud in insurance on rise Survey 201011 by Ernst & Young India Mumbai: Four held for duping widow of husband's life insurance money Mid-Day Jan 24 2012 Four sentenced to jail terms for clearing bogus insurance claim Zee News Dec14th 2012 7. 7 Regulators View IRDA in January 2013 came out with guidelines on Insurance Fraud Monitoring Framework. The guidelines requires insurance companies & reinsurers to 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 & internal frauds. The compliance reports are due to be filed by 30th June 2013. The stipulations on fraud detection, classification, monitoring and reporting is effective from Financial Year 2013-14 8. 8 Avenues for Frauds Policyholder Intermediaries Employees Fraud Consequence Monetary Loss Reputation Lost business Regulatory actions 9. 9 Fraud Risk Management Framework Fraud Risk Assessment Anti-Fraud Procedures Fraud Investigations Anti-Fraud Culture Anti-Fraud Governance Respond 10. 10 Anti Fraud Program 10 Governance Risk Management Committee Fraud Policy Monitoring Reports Due Diligence on Staff & Intermediaries Fraud Response Internal & external reporting Fraud Investigation Manual Coordination with authorities Fraud Assessment Identifying potential fraud in products & processes Control Gap analysis Antifraud manual & procedures Fraud monitoring Fraud Risk Management Program Fraud Awareness Staff training, induction raining & refresher Fraud manual & SOPs Reporting process Whistle-blower policy 11. 11 Key Stipulations from IRDAs Circular Governance 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 reports Fraud 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 and mitigation of frauds Red flags for fraud monitoring 12. 12 Fraud Response and Awareness Fraud Response Internal & external fraud reporting Fraud investigation manual Legal process for any crimes under CRPC Coordination with law enforcement Fraud Awareness Staff training, induction raining & refresher Fraud manuals & SOPs Clear process of internal & external fraud reporting Whistle blower policy & procedure Awareness to intermediaries & policyholders 13. 13 RiskPro Approach Fraud Risk Identification Fraud Prevention/ Detection Fraud Reporting Identify fraud scenarios & factors for products and processes Assess likelihood of occurrence and resultant impact on the organization Fraud policy with clear accountabilities & fraud response Fraud Manual & SOPs Whistle-blower policy Anti Fraud Manual Continuous monitoring of fraud via indicators Awareness training Define reporting process for internal & external reporting Define coordinated approach for Investigation & corrective actions Other Policies such as HR Disciplinary policy 14. 14 RiskPros Offering Area Objective RiskPro Service Offering Fraud Risk Assessment To identify the organizations susceptibility to specific types of fraud and the likelihood and significance of those frauds Identify fraud scenarios & factors for products and processes Assess likelihood of occurrence and resultant impact on the organization Control gap Assessment To assess effectiveness of anti-fraud controls and implement or improve control measures to appropriately manage identified fraud risks Test existing controls Identify control gaps Recommend control enhancements Anti-Fraud Procedures To enable an organization to structure Its operating policies & procedures so that fraud will be detected if it occurs, and ascertain that its anti-fraud policies and procedures are well constructed, properly communicated and followed Fraud policy with clear accountabilities & fraud response Fraud Manual & SOPs Whistle-blower policy Fraud Monitoring Reports Fraud Awareness Training To enable an organizations employees, officers, directors and agents to identify and respond appropriately to the signs of fraud Awareness & specialised anti-fraud training with hands-on case studies to staff and intermediaries 15. 15 Riskpro Clients Our Clients *Any trademarks or logos used throughout this presentation are the property of their respective owners Banking/ Insurance Corporate MNC Banking Intl Consulting IT / Others 16. 16 Team Experiences Our Experiences Our team members have worked at world class Companies *Any trademarks or logos used throughout this presentation are the property of their respective owners 17. 17 RESUMES 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 in Operational 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 and abroad. Worked with KPMG United Arab Emirates, PKF South Africa, Ernst and Young Kuwait, 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. Major clients include banks, investment companies, manufacturing organizations, aviation etc. RahulBhan Credentials 18. 18 RESUMES - Our team Co-Founder - Riskpro PGD (Electrical & Electronics & Computer Programming) 30 years of experience in Information & Communications Technology (ICT) Solutions for 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 Syst