Senior Executive - Risk and Loss Mitigation

PeopleStrong; New Delhi; On-site; INR 600,000 - 900,000; Full time

Job summary

HDFC ERGO General Insurance is seeking a Senior Executive - Risk and Loss Mitigation in New Delhi/Noida. The role involves physical field investigations of claims, verification, and reporting to insurers and corporates.

The incumbent will gather evidence through hospital/diagnostic center visits and ensure compliance throughout the investigation process. Medical graduates with health insurance exposure (claims investigation/processing) and strong Excel/computer skills are preferred.

Qualifications

• Field investigation and claims verification experience.
• Health insurance industry experience preferred, esp. investigations/processing.
• Proficient in Excel and computer usage.

Responsibilities

• Conduct physical field investigations of claims assigned through system.
• Perform field visits to hospitals, pharmacies, and diagnostic centers; collect evidences and report outcomes to insurers and corporates.
• Prepare findings reports and guide actions; analyze facts and develop evidence for court use if required.
• Submit reports in the CIMA in-house system used for investigations.
• Maintain healthy relationships with hospitals and TPA desk.
• Ascertain evidence quality and validate against case triggers.
• MIS preparation and report reconciliation.
• Ensure ethics and compliance during investigations of claims.
• Analyze data on utilization and outcomes to identify trends and cost-saving opportunities.
• Present findings to management with recommendations for improvements in claims processing.
• Identify hospitals/individuals involved in malpractices to build a database.
• Escalation and grievance management for investigated cases.

Skills

Graduation

Excel

Computers

Education

Medical graduates (BAMS/BHMS/BPT/BDS)

Tools

Excel

Computers

Job description

Senior Executive - Risk and Loss Mitigation

HDE/JC/17838

• HDFC ERGO General Insurance


• India>North>Uttar Pradesh>New Delhi>New Delhi - Noida>New Delhi - Noida>1304>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 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 North

Physical Branch New Delhi - Noida

Branch Code 1304

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