Deputy Manager - Risk and Loss Mitigation

HDFC ERGO General Insurance; Mumbai; On-site; INR 1,200,000 - 2,600,000; Full time

Job summary

HDFC ERGO General Insurance invites applications for Deputy Manager – Risk and Loss Mitigation (Health Claims Investigation) in Mumbai. The role emphasizes field investigations, hospital visits, and gathering evidence to support insurers and corporate clients.

You will prepare reports, validate evidence, manage MIS, and ensure ethical investigation practices while identifying cost-saving opportunities in claim processing.

Qualifications

• Graduation is required with relevant healthcare/insurance exposure.
• Medical graduates with health insurance industry experience preferred.
• Excel and computer proficiency expected.

Responsibilities

• Physical field investigation of claims assigned through system.
• Perform field visits to hospitals, pharmacies, and diagnostic centers; collect evidence and report for insurers and corporates.
• Prepare reports based on findings and validate evidence against case triggers.

Skills

Graduation

Education

Medical Graduates (BAMS/BHMS/BPT or BDS)

Tools

Excel

Computer literacy

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

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.