Deputy Vice President - Risk And Loss Mitigation

Role & Designation: M3 DVP/ JVP  

(Health & Accident Claim Investigation & Analytics) 

Job Description 

• Experience in investigation 10 Years with a insurance company 

• QC of claims in investigation module 

• QC of field visits to hospitals, pharmacies, diagnostic centers etc, and ensuring all evidences in place 

• Preparing reports based on findings and observations and guide / Gathering and analyzing data 

• Periodic analysis of hospitals on network and conducting audits in line with investigation findings  

• 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 

• 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