- · 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 - Risk and Loss Mitigation (Maharashtra)
🏢 HDFC ERGO General Insurance
📍 Maharashtra