Senior Executive - Risk and Loss Mitigation

PeopleStrong; Hubli; On-site; INR 450,000 - 600,000; Full time

Job summary

HDFC ERGO General Insurance is seeking a Senior Executive - Risk and Loss Mitigation to conduct physical investigations of claims, perform field visits to hospitals and diagnostic centers, and compile conclusive reports for insurers and corporates. The role emphasizes ethical investigations, data gathering, and evidence development for appropriate action.

Ideal candidates hold medical graduation with insurance claim experience, strong Excel skills, and the ability to manage MIS and compliance

Qualifications

• Medical graduates with health insurance industry experience preferred.
• Experience in claims investigation/ processing preferred.
• Proficiency in Excel and computers.

Responsibilities

• Perform physical field investigations of claims assigned in the system.
• Conduct field visits to hospitals, pharmacies, diagnostic centers, collect evidences and report to insurers or corporates.
• Prepare reports based on findings and develop evidence for court submissions if needed.
• Submit MIS reports and reconcile data.
• Ensure ethics and compliance during investigations and identify malpractices.

Skills

Graduation

Excel

Computer skills

Education

BAMS/BHMS/BPT/BDS (Medical Graduation)

Tools

CIMA system

Job description

Senior Executive - Risk and Loss Mitigation

HDE/JC/17861

• HDFC ERGO General Insurance
• India>South>Karnataka>Hubli>Hubli>Hubli>4208>Branch

Posted On 15 Sep 2026

End Date 15 Sep 2027

Required Experience 0 - 1 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 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 South

City Hubli

Physical Branch Hubli

Branch Hubli

Branch Code 4208

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