Senior Executive - Risk and Loss Mitigation

HDFC ERGO General Insurance; Bengaluru; Presencial; INR 350.000 - 650.000; Tempo integral

Resumo da vaga

HDFC ERGO General Insurance in Bengaluru is recruiting a Senior Executive - Risk and Loss Mitigation to conduct field investigations of claims and coordinate with hospitals, TPAs, and insurers. The role involves collecting evidence, preparing detailed reports, and ensuring compliance and ethics in investigations.

The candidate should have medical graduation and exposure to health insurance claims investigation/processing.

Qualificações

• Field investigation of claims assigned through system.
• Handling physical verification and field visits to hospitals, pharmacies, and diagnostic centers.
• Gathering evidence and reporting for action to insurers/corporates.
• MIS preparation and data reconciliation.

Responsabilidades

• 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

Conhecimentos

Graduation

Formação

Medical Graduate (BAMS/BHMS/BPT/BDS)

Descrição da vaga

Senior Executive - Risk and Loss Mitig...

HDE/JC/17836

• HDFC ERGO General Insurance
• India>South>Karnataka>Bangalore>Bangalore - MG Road>Bangalore - MG Road>4207>Corporate

Posted On 10 Sep 2026

End Date 10 Sep 2027

Required Experience 0 - 5 years

Basic Section

New Job Title Senior Executive - Risk and Loss Mitigation

No. Of Openings 1

Grade JM1

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 Risk and Loss Mitigation

Business Zone NA

Job Role Team Member

Country India

Region South

Physical Branch Bangalore - MG Road

Branch Code 4207

Type of Office Corporate

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