- 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

Required Qualifications:
- Medical Graduates such as BAMS/BHMS/BPT or BDS with working experience of Health insurance industry preferably with Claims investigation/ processing experience
- Excel and computer

• Medical degree: BHMS / BAMS / BDS / BPT

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