- 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

📌 Deputy Manager (Ahmednagar)
🏢 HDFC ERGO General Insurance
📍 Ahmednagar