Senior Executive - Risk And Loss Mitigation

Position

Manager – Risk & Loss Mitigation

Location

Delhi – Nehru Place

Reports to

Category

Level

M

Our Vision

To be the most admired insurance company that enables the continued progress of customers by being responsive to their needs

Our Values

• Sensitivity
• Excellence
• Ethics
• Dynamism

About HDFC Ergo General Insurance Co., Ltd.,

HDFC ERGO is a 51:49 joint venture firm between HDFC and ERGO International AG, one of the insurance entities of the Munich Re Group in Germany operating in the insurance field under the BFSI sector. The company offers products in the retail, corporate and rural sectors. The retail sector products are health, motor, travel, home, personal accident, and cybersecurity policy. Corporate products include liability, marine, and property insurance. 

Our vision is to be the most admired insurance company that enables the continued progress of customers by being responsive to their needs. 

Key Roles &Responsibilities

Primary Responsibilities:

· Investigation manger

· Claim Investigation Allocation of assigned claims to respective vendors with case relevant triggers

· Follow up for IR and TAT management

· Level 1 QC clearance & validate the submissions against shared triggers

· Success in claim investigation based upon strong medical & legal evidences

· 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 and coordination with claims team.

· Evidence Matrix Assurance Ascertain evidence quality as per matrix Validate each & every evidence with the

case triggers

· Escalation Management

· Payment reconciliation with Vendors Project tracking Vendor Management Vendor Empanelment & Training

& Development

· Ensure the ethics and compliance during managing the external investigators and self- investigation of cases

· Vendor Payment Reconciliation

Others :

1. Handling physical verification, field visits to hospitals, pharmacies, diagnostic centers etc, collect evidences

and report for further action to Insurers, Corporates etc.

2. Analyze data on utilization, outcomes and costs to determine trends and identify problem areas.

3. 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.

4. Desktop Investigation Trigger identification through data at intimation/Referral stage

5. Social media searches

6. Cold calling using digital platforms Identify key business people, link analysis

Key Requirements – Education & Certificates

• Medical degree: MBBS/ BHMS / BAMS / BDS or any medical qualification.

• Experience Range: 1-3 year.

• Attention to detail and quality focused

• Good analytical and comprehension skills.

Key Requirements - Experience &Skills

Preferred Experience:

• Fraud control and investigation

• Claims processing

• Health Insurance knowledge

• Working in hospital

• Knowledge on investigations & its procedures.

• Medical record familiarity