Senior Executive - Risk and Loss Mitigation

PeopleStrong; Pune District; On-site; INR 600,000 - 900,000; Full time

Job summary

HDFC ERGO General Insurance is seeking a Senior Executive - Risk and Loss Mitigation to conduct physical field investigations of health claims and gather evidence for insurers, corporates, and TPAs. You will prepare detailed reports, validate evidence, and ensure compliance with ethics in investigation.

The role requires 3–6 years of relevant experience, expertise in hospital management, and strong analytical skills.

Qualifications

• Medical graduates (BAMS/BHMS/BPT/BDS) with health insurance claims experience.
• Experience range: 3–6 years.
• MS Excel knowledge and general computer skills.
• First reference to Insurance Industry experience.
• Practical clinical management knowledge in hospitals.
• Good analytical and comprehension skills.
• Knowledge of investigations and its procedures.

Responsibilities

• Perform physical field investigations of claims.
• Collect evidence with hospitals/TPA and report to insurers.
• Prepare reports and analyze facts for court readiness.
• Submit reports in CIMA system.
• Maintain relations with hospitals and TPAs.
• Identify trends and propose cost-saving claim processing improvements.
• Filing police complaints and coordinate with authorities for frauds.

Skills

Graduation

Education

Medical Graduates (BAMS/BHMS/BPT/BDS)

Tools

Excel

Computer

Job description

Senior Executive - Risk and Loss Mitigation

HDE/JC/14941

• HDFC ERGO General Insurance
• India>West>Maharashtra>Pune>Pune>Pune>2109>Corporate

Posted On 23 Jan 2026

End Date 23 Jan 2027

Required Experience 1 - 3 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 RLMU

Business Zone NA

Job Role TM-FCI

Country India

Region West

State Maharashtra

City Pune

Physical Branch Pune

Branch Pune

Branch Code 2109

Type of Office Corporate

Skills

• Graduation

Job Description

• Role & Designation : JM1 / JM2 (Health Claim Investigation)
• Job Description
• Physical field Investigation of claimassignedthroughsystem.
• Handling physical verification, field visits to hospitals, pharmacies, diagnostic centersetc, collectevidencesand report for further action to Insurers,Corporatesetc.
• 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 beingusedforInvestigation)
• 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 onutilization, outcomes todeterminetrends andidentifyproblem 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
• Experience Range: Minimum 3 – 6 years
• Excel and computer
• Preferred Work experience
• First reference to Insurance Industry experience
• Practical experience of clinical management in hospitals
• Knowledgeoninvestigations &itsprocedures.
• Medical record familiarity
• Good analytical and comprehension skills.