About the Company
Niva Bupa Health Insurance Company Limited is a Public Listed Company on Stock exchange(s). The company's purpose is to give every Indian the confidence to access the best healthcare. It intends to play the role of an enabler in the lives of its customers and help them live life without constraints. This is reflected in its brand philosophy – 'Zindagi Ko Claim Kar Le'. As of March 31, 2026, Niva Bupa had over 210 physical branches across India. It additionally offers health insurance through its ecosystem partners including 2.4 Lakh agents, close to 600 brokers, and over 120 Banca & Other Corporate Agency Partners. The company currently covers over 25 million lives and has over 10,500 hospitals empanelled in its hospital network. Niva Bupa has consistently maintained 90%+ claim settlement ratio over the last 5 financial years. With an employee base of over 10,100 people, the company is a certified Outstanding Place to Work six times in a row.
About the Role
The Zonal Manager – Health Claims Investigation delivers strategic governance for the zonal fraud control framework. The role maintains strict vigilance on evolving fraud patterns, gathers market intelligence, oversees Team Leaders (TLs), in-house investigators, and external agencies, and onboard new vendor capabilities. Key focus areas include workflow innovation, strict SLA tracking, investigative quality, and absolute regulatory compliance.
Responsibilities
Fraud Vigilance & Market Intelligence
Monitor health/accident claim trends to detect emerging fraud patterns early. Gather market intelligence on regional fraud syndicates, provider alliances, and systemic risks. Prescribe complex forensic lines of inquiry for high-stakes fraud cases escalated by team. Convert historical data and market insights into predictive indicators to stop claims leakage. Agency Evaluation & Onboarding
Source and evaluate new external investigation agencies based on expertise and footprint. Conduct reference checks and ca