Summary
Overview
Work History
Education
Skills
Certification
Timeline
Work Availability
Generic

Pradnya Talekar

Fraud Control, Ethics And Compliance
Mumbai

Summary

Seasoned fraud control and investigation professional with over 10 years of experience in the insurance industry, specializing in identifying, investigating, and mitigating fraudulent activities within Life & General Insurance sectors, particularly Employee Fraud investigation, Risk Control and Third-Party Motor claim. Proven ability to manage complex investigations, analyze data, identify fraudulent patterns, and implement effective control measures to minimize organizational losses and enhance profitability. Adept at collaborating with cross-functional teams, including HR, legal, sales, and operations, to ensure compliance with regulatory requirements and industry best practices. Skilled in developing and delivering training programs on fraud awareness, prevention, and investigation techniques, fostering a culture of compliance and risk mitigation. Demonstrated ability to build and lead high-performing teams, providing guidance, mentorship, and support to achieve organizational objectives. Successfully implemented innovative investigation techniques and leveraged technology to streamline processes, reduce investigation turnaround time, and improve efficiency. Recognized for outstanding investigative abilities, receiving the "Independent Investigative Ability" award for FY 2018-19. Proven ability to manage vendor relationships, negotiate contracts, and ensure high-quality service delivery within budget constraints. Strong analytical, problem-solving, and decision-making skills, with a keen eye for detail and a commitment to accuracy and integrity. Excellent communication, interpersonal, and presentation skills, capable of conveying complex information clearly and concisely to diverse audiences. Proficient in using a variety of investigative tools and techniques, including data analysis software, surveillance systems, and background check databases. Deep understanding of insurance industry regulations, fraud trends, and investigation methodologies. Proven ability to work independently and as part of a team, effectively managing multiple priorities and meeting deadlines in a fast-paced environment. Strong work ethic, highly motivated, and results-oriented, with a passion for fraud prevention and a commitment to upholding ethical standards.

Overview

20
20
years of professional experience
2
2
Certificates

Work History

Senior Manager Fraud Control and Investigation

HDFC ERGO GENERAL INSURANCE
02.2023 - 10.2025
  • Responsible for minimizing financial losses, ensuring regulatory compliance, and maintaining the integrity of the company's claims process.
  • Led fraud control initiatives for third-party motor claims across Maharashtra, collaborating with investigators, the legal team, and law enforcement agencies to minimize fraudulent activities and enhance profitability.
  • Developed and implemented innovative investigation techniques to identify, investigate, and resolve fraudulent claims, improving efficiency and reducing investigation turnaround time.
  • Managed a high-performing network of investigators, ensuring comprehensive coverage, conducting regular performance reviews, and providing ongoing training to maintain high standards of investigation quality.
  • Collaborated with the legal team to build strong cases against fraudulent activities, leading to successful prosecutions, and strengthening the company's legal standing.
  • Oversaw all aspects of third-party motor claims fraud investigations, from initial reporting, data analysis, evidence gathering, witness interviews, and final reporting.
  • Conducted a thorough analysis of claims data, identifying patterns, trends, and anomalies indicative of fraudulent activities, and developing proactive strategies to mitigate future risks.
  • Implemented effective vendor management practices, including contract negotiation, performance monitoring, and regular communication, to ensure high-quality service delivery within budget constraints.

Manager Risk Control Unit

FUTURE GENERALI INDIA LIFE INSURANCE CO. LTD
10.2019 - 10.2022
  • Responsible for protecting the financial interests of the company, maintaining regulatory compliance, and upholding the integrity of insurance operations.
  • Managed the risk control function, specializing in identifying, investigating, and mitigating fraudulent activities related to new business applications and death claims.
  • Utilized data analysis techniques and investigative tools to identify and investigate potentially fraudulent activities, including suspicious claims, high-risk applications, and unusual activity patterns.
  • Conducted thorough investigations, including document verification, customer interviews, site visits, and collaboration with law enforcement agencies, to gather evidence and determine the validity of claims.
  • Developed and implemented enhanced risk assessment procedures, incorporating industry best practices and regulatory requirements, to strengthen fraud prevention and detection mechanisms.
  • Collaborated with cross-functional teams, including underwriting, claims, and legal, to share information, coordinate investigations, and develop comprehensive risk mitigation strategies.
  • Presented findings of investigations and recommendations for risk mitigation to senior management, influencing policy changes, and improving overall fraud prevention efforts within the organization.
  • Managed relationships with external vendors, including investigation agencies and data providers, ensuring quality service delivery, adherence to contractual obligations, and cost-effectiveness.

Senior Executive Sales Quality Complaints and Fraud Investigation Cell

SBI LIFE INSURANCE CO. LTD
11.2015 - 09.2019
  • Responsible for upholding the integrity of sales operations, mitigating financial losses due to fraudulent activities, and ensuring compliance with regulatory requirements and company policies.
  • Conducted investigations into alleged fraudulent activities, including mis-selling, policy churning, and premium misappropriation, ensuring compliance with regulatory requirements and company policies.
  • Examined and verified policy documents, financial transactions, and customer communications to gather evidence, identify inconsistencies, and determine the validity of complaints.
  • Interviewed complainants, witnesses, and involved parties to gather information, clarify allegations, and establish a comprehensive understanding of the case.
  • Collaborated with internal departments, including Sales, Underwriting, and Legal, to share information, coordinate investigations, and develop appropriate remedial actions.
  • Prepared detailed investigation reports, summarizing findings, presenting evidence, and recommending actions to senior management, contributing to informed decision-making regarding policy violations, and disciplinary actions.
  • Developed and implemented enhanced fraud awareness training programs for sales personnel, educating them on ethical practices, regulatory guidelines, and fraud prevention techniques.

Executive Emerging Business

SBI LIFE INSURANCE CO. LTD
05.2013 - 10.2015
  • Responsible for supporting the company's business development goals, enhancing agent productivity, and expanding the customer base.
  • Contributed to the development and expansion of the company's distribution network, identifying and onboarding new agents to increase market reach and sales growth.
  • Organized and facilitated regional strategy meetings and training programs for agents, focusing on product knowledge, sales techniques, and customer relationship management, to enhance sales effectiveness and improve customer satisfaction.
  • Participated in a strategic initiative to develop and implement targeted marketing campaigns for the Retail Agency Channel in major metropolitan cities, aiming to increase brand visibility, generate leads, and drive sales growth.

Associate Learning and Development Department

SBI LIFE INSURANCE CO. LTD
02.2007 - 04.2013
  • Responsible for supporting employee development initiatives, enhancing skills and knowledge across the organization, and contributing to a culture of continuous learning.
  • Managed the logistics and coordination of training programs, ensuring smooth execution and a positive learning experience for participants.
  • Prepared and managed the annual training calendar and budget, aligning training initiatives with organizational goals and optimizing resource allocation.
  • Maintained and updated training records for all employees across India, ensuring data accuracy and providing insights for performance management and succession planning.

Associate Human Resource

CAPGEMINI INDIA PVT. LTD.
08.2006 - 01.2007

Backoffice Assistant

TATA SHARE REGISTRY LTD.
01.2006 - 06.2006

Account Assistant

V.VAIDYANATHAN & COMPANY
08.2005 - 12.2005

Education

PGDHRM - Human Resources Development

Symbiosis (SCDL)
Pune
09-2010

Bachelor of Commerce - Financial Accounting

Mumbai University
Mumbai, India
03-2004

Skills

Communication

Certification

Fraud Detection and Prevention - Alison – The CPD Certification Service

Timeline

Senior Manager Fraud Control and Investigation

HDFC ERGO GENERAL INSURANCE
02.2023 - 10.2025

Manager Risk Control Unit

FUTURE GENERALI INDIA LIFE INSURANCE CO. LTD
10.2019 - 10.2022

Senior Executive Sales Quality Complaints and Fraud Investigation Cell

SBI LIFE INSURANCE CO. LTD
11.2015 - 09.2019

Executive Emerging Business

SBI LIFE INSURANCE CO. LTD
05.2013 - 10.2015

Associate Learning and Development Department

SBI LIFE INSURANCE CO. LTD
02.2007 - 04.2013

Associate Human Resource

CAPGEMINI INDIA PVT. LTD.
08.2006 - 01.2007

Backoffice Assistant

TATA SHARE REGISTRY LTD.
01.2006 - 06.2006

Account Assistant

V.VAIDYANATHAN & COMPANY
08.2005 - 12.2005

PGDHRM - Human Resources Development

Symbiosis (SCDL)

Bachelor of Commerce - Financial Accounting

Mumbai University

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Pradnya TalekarFraud Control, Ethics And Compliance