Senior Executive - Risk and Loss Mitigation

PeopleStrong; Bengaluru; On-site; INR 400,000 - 650,000; Full time

Job summary

HDFC ERGO General Insurance is seeking a Senior Executive for Risk and Loss Mitigation to conduct physical investigations of claims, verify evidence, and report findings. You will coordinate with hospitals, TPAs, and insurers, ensuring ethical investigation practices and compliance.

The role requires handling data, preparing MIS reports, and presenting actionable insights to reduce costs and improve claim processing efficiency at our Bangalore office.

Qualifications

• Graduation is required.
• Proficiency with Excel and computer applications.

Responsibilities

• Physical field investigation of claims assigned through system.
• Handle field verifications, visits to hospitals/pharmacies/diagnostic centers, collect evidence and report to insurers/corporates.
• Prepare reports based on findings and guide actions; gather and analyze facts to create evidence for court.
• Submit reports in CIMA (in-house investigation system).
• Maintain cordial relationships with hospitals and TPA desks.
• Ensure evidence quality against case triggers and reconcile MIS reports.
• Adhere to ethics and compliance during investigations and analyze data to identify trends and cost-saving opportunities.
• Present findings to management with recommendations for long- and short-term improvements.

Skills

Graduation

Education

BAMS/BHMS/BPT/BDS

Tools

Excel

Computer

Job description

Senior Executive - Risk and Loss Mitigation

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

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

End Date 10 Sep 2027

Required Experience 0 - 5 years

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