Deputy Manager - Risk and Loss Mitigation

PeopleStrong; Mumbai; On-site; INR 800,000 - 1,400,000; Full time

Job summary

HDFC ERGO General Insurance invites applications for the Deputy Manager - Risk and Loss Mitigation in Mumbai. The role focuses on health claim investigations, field verifications, and gathering evidence to support insurers and corporates.

You will analyze data, prepare MIS reports, and ensure ethical, compliant investigations with coordination among hospitals, TPAs, and authorities when necessary.

Qualifications

• Medical graduates with health insurance industry experience preferred, esp. claims investigation/processing.
• Strong analytical and comprehension skills are essential.

Responsibilities

• Physically investigate health claims and verify evidence.
• Coordinate field visits to hospitals, diagnostic centers, and pharmacies; gather reports for insurers and corporates.
• Prepare findings-based reports; ensure evidence meets case triggers and maintain MIS reconciliations.
• Maintain proper ethics and compliance during investigations and escalate as needed.
• Identify fraud indicators, document investigations, and liaise with police authorities when required.

Skills

Graduation

Education

Medical Graduates (BAMS/BHMS/BPT/BDS)

Tools

Excel

Computer

Job description

Deputy Manager - Risk and Loss Mitigatio...

HDE/JC/14923

• HDFC ERGO General Insurance
• India>West>Maharashtra>Mumbai>Mumbai - Andheri LBP>Mumbai - Andheri LBP>2101>Corporate

Posted On 22 Jan 2026

End Date 22 Jan 2027

Required Experience 1 - 4 years

Basic Section

New Job Title Deputy Manager - Risk and Loss Mitigation

No. Of Openings 1

Grade JM2

Campus/Non Campus Non Campus

Employment Type Permanent

Organisational

Company HDFC ERGO General Insurance

Legal Entity HDFC ERGO General Insurance

SBU/ Channel Enabling Function

Business Function Non Sales

Cost Center Risk and Loss Mitigation

Cost Center Code 1671

Department Risk and Loss Mitigation

Function RLMU

Business Zone NA

Job Role TM-FCI

Country India

Region West

State Maharashtra

Branch Code 2101

Type of Office Corporate

Skills

Skill

Graduation

CERTIFICATION

Working Language

Job Description

Role & Designation : JM1 / JM2 (Health Claim Investigation)

Job Description

Physical field Investigation of claimassignedthroughsystem.

Handling physical verification, field visits to hospitals, pharmacies, diagnostic centersetc, collectevidencesand report for further action to Insurers,Corporatesetc.

Preparing reports based on findings and observations and guide / Gathering and Analyzing the facts and developing & creating evidence which stands in court of law

Report submission in CIMA (In house system that is beingusedforInvestigation)

Maintain healthy and cordial relationship with hospitals and TPA desk.

Ascertain evidence quality as per matrix Validate each & every evidence with the case triggers

MIS preparation and report reconciliation

Ensure the ethics and compliance while investigating a claim

Analyze data onutilization, outcomes todeterminetrends andidentifyproblem areas.

Present findings to the management, which may include reviews, proposed solutions, and implementation of long- and short-term solutions for improvements in claim processing and cost savings.

Identification of Hospitals/ individuals involved in malpractices to create database

Escalation &Grievance Management for the investigated cases

Filing of police complaints and liaising with the police authorities for taking necessary action against fraudulent individuals / hospital and others

Required Qualifications:

Medical Graduates such as BAMS/BHMS/BPT or BDS with working experience of Health insurance industry preferably with Claims investigation/ processing experience

Experience Range: Minimum 3 – 6 years

Excel and computer

Preferred Work experience

• First reference to Insurance Industry experience
• Practical experience of clinical management in hospitals
• Knowledgeoninvestigations &itsprocedures.
• Medical record familiarity
• Good analytical and comprehension skills.