Manager - Risk and Loss Mitigation
Manager - Risk and Loss Mitigation
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Job Description
Location
MumbaiLBP/Pune
Department
Risk & Loss Mitigation
Reports to
Deputy Vice President (Umasevak Pal)
Category
Level
M/M1
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 :
- Handling physical verification field visits to hospitals pharmacies diagnostic centers etc collect evidences
- and report for further action to Insurers Corporates etc.
- Analyze data on utilization outcomes and costs to determine trends and identify problem areas.
- Present findings to the management which may include reviews proposed solutions and implementation of
- long and shortterm solutions for improvements in claim processing and cost savings.
- Desktop Investigation Trigger identification through data at intimation/Referral stage
- Social media searches
- Cold calling using digital platforms Identify key business people link analysis
Key Requirements Education & Certificates
- Medical degree: Medical Graduates i.e. MBBS/ BHMS / BAMS / BDS/BPT
- Experience Range: 57 years.
- 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
- Knowledge on investigations & its procedures.
- Medical record familiarity
Regards
From:Khushboo Singh (Deputy Manager Human Resources) <>
Sent: Monday December:21
To: Rajat Goyal (Senior Vice President Risk And Loss Mitigation) <>; Rakhi Dave (Assistant Vice President Human Resources) <>; Umasevak Pal (Deputy Vice President Risk and Loss Mitigation) <>
Subject: Re: ITM for Position at Mumbai / Pune A&H Investigations
Dear Team
I am awaiting response to release the ITM.
Wishing good health for you and your loved ones.
Khushboo Singh
Deputy Manager Human Resources.
From: Khushboo Singh (Deputy Manager Human Resources) <>
Sent: Friday December:16 PM
To: Rajat Goyal (Senior Vice President Risk And Loss Mitigation) <>; Rakhi Dave (Assistant Vice President Human Resources) <>; Umasevak Pal (Deputy Vice President Risk and Loss Mitigation) <>
Subject: Re: ITM for Position at Mumbai / Pune A&H Investigations
Dear Umasevak
Please help me with JD or some KRA so that I can prepare the ITM job discription
Below is the JD that I have please suggest if any changes
JOB PROFILE
Reports to
Category
Level
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 en
Required Experience:
Manager
Employment Type
Full-Time
