Manager - Risk and Loss Mitigation

HDFC ERGO General Insurance; New Delhi; On-site; INR 900,000 - 1,500,000; Full time

Job summary

HDFC ERGO General Insurance invites applications for the Manager - Risk and Loss Mitigation role in Delhi. The role involves physical field investigations of claims, site visits to hospitals, and collecting evidences for insurers and corporates.

You will prepare reports, validate evidence, maintain relationships with hospitals and TPAs, escalate grievances, and help identify fraud, with MIS reporting and cost-saving measures.

Qualifications

• Graduation required; health insurance experience preferred.
• Excel skills and basic computer proficiency essential.
• Field investigations and report preparation experience advantageous.

Responsibilities

• Physical field investigation of claims 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 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

Skills

Graduation

Excel

Computer literacy

Education

Medical Graduates such as BAMS/BHMS/BPT or BDS

Job description

Posted On 10 Sep 2026

End Date 10 Sep 2027

Required Experience 0 - 5 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

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