Assistant Investigation Manager

Vidal Health Insurance; Gurugram District; On-site; INR 900,000 - 1,500,000; Full time

Job summary

Vidal Health Insurance TPA seeks an experienced Assistant Manager to lead the Investigation department, handling suspicious and high-value claims within a health insurance TPA environment. You will guide the investigation process and drive risk controls.

The role requires identifying fraud patterns, reviewing records, and coordinating with hospitals, insurers and internal teams to ensure compliant, thorough investigations and timely reporting.

Qualifications

• BHMS/BDS/BAMS/BUMS degree required.
• 4-6 years of experience in TPA/Health Insurance investigations.
• Experience leading investigations in a health insurance setting.

Responsibilities

• Lead investigation of suspicious and high-value health insurance claims.
• Identify fraud patterns (inflated billing, unnecessary hospitalization, document manipulation).
• Conduct hospital audits and field investigations.
• Review medical records, bills and claim documents for discrepancies.
• Coordinate with hospitals, insurers and internal teams.
• Prepare investigation reports with findings and recommendations.
• Ensure compliance with IRDAI guidelines and internal processes.
• Track MIS, dashboards and fraud trends.
• Manage and guide investigation team members.

Skills

Fraud detection

Health insurance claims

Stakeholder management

Analytical skills

Education

BHMS/BDS/BAMS/BUMS

Job description

Vidal Health Insurance TPA is looking for Assistnat Manager for Investigation dpt

Location:Gurgaon,Udhyog Vihar Phase 5

Experience: 4-6 Years

Qualifications

• BHMS/BDS/BAMS/BUMS

Role Overview

We are looking for an experienced professional to lead the Investigation function within a Health Insurance TPA environment. The role involves handling suspicious and high-value claims, identifying fraud patterns, and ensuring effective risk control.

Key Responsibilities

• Lead investigation of suspicious and high-value health insurance claims
• Identify fraud patterns (inflated billing, unnecessary hospitalization, document manipulation, etc.)
• Conduct hospital audits and field investigations
• Review medical records, bills, and claim documents for discrepancies
• Coordinate with hospitals, insurers, and internal teams
• Prepare investigation reports with findings and recommendations
• Ensure compliance with IRDAI guidelines and internal processes
• Track MIS, dashboards, and fraud trends
• Manage and guide investigation team members

Key Requirements

• Strong knowledge of health insurance claims (cashless & reimbursement)
• Experience in fraud detection and hospital/provider investigations
• Understanding of medical billing and documentation
• Good analytical and report-writing skills
• Strong stakeholder management skills

Qualifications

• BHMS/BDS/BAMS/BUMS
• 4-6 years of experience in TPA / Health Insurance investigations

Why Join Us

• Opportunity to work in a critical risk control function
• Exposure to complex and high-impact cases
• Leadership role with team management responsibility