Manager - Risk and Loss Mitigation

PeopleStrong; Indore District; On-site; INR 1,400,000 - 2,100,000; Full time

Job summary

HDFC ERGO General Insurance seeks a Manager for Risk and Loss Mitigation to conduct physical field investigations of claims, perform verification at hospitals and diagnostic centers, and compile reports for insurers and corporates. The role emphasizes data-driven insights, ethics, and cost-saving measures.

Required experience ranges 10–20 years in risk and loss mitigation, with a medical background such as BAMS/BHMS/BPT or BDS, and proficiency in Excel.

Qualifications

• Graduation in medical field or related health qualifications.
• Experience with health insurance claims investigation/processing is preferred.
• Proficiency in Excel and basic computer skills.

Responsibilities

• Physical field investigation of claims assigned through system.
• Conduct field visits to hospitals, pharmacies, and diagnostic centers to collect evidence.
• Prepare reports based on findings and guide action by insurers/ corporates.
• Submit reports in the internal system (CIMA) and reconcile MIS.
• Maintain ethical standards and ensure compliance during investigations.
• Identify trends from data to suggest improvements in claim processing and costs.

Skills

Graduation

Job description

Posted On 10 Sep 2026

End Date 10 Sep 2027

Required Experience 10 - 20 years

Basic Section

New Job Title Manager - Risk and Loss Mitigation

No. Of Openings 1

Grade M

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 Risk and Loss Mitigation

Cost Center Risk and Loss Mitigation

Cost Center Code 1671

Department Risk and Loss Mitigation

Function Risk and Loss Mitigation

Business Zone NA

Job Role TM-FCI

Country India

Region West

Branch Code 2403

Type of Office Branch

Skills

Skill

Graduation

CERTIFICATION

Working Language

Job Description

Physical field Investigation of claim assigned through system.

Handling physical verification, field visits to hospitals, pharmacies, diagnostic centers etc, collect evidences and report for further action to Insurers, Corporates etc.

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 being used for Investigation)

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 on utilization, outcomes to determine trends and identify problem 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

Excel and computer