Claims Processor

Hi , Hope you are doing well! HDFC ERGO is hiring for Risk and loss mitigation for Kochi Location Please find the Job Description for the profile of Risk and loss mitigation below: • Physical field Investigation of claim assigned through system. Handling physical verification, field visits to hospitals, pharmacies, diagnostic centers etc, collect evidence 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 Key Requirements – Education & Certification • Medical Graduates such as BAMS/BHMS/BPT / BDS or Any Graduate with working experience of Health insurance industry preferably with Claims investigation/ processing experience Location - Chennai, Hyderabad and Guntur, Kōchi Budget-5 LPA Designation-Deputy Manager / Senior Executive Interested candidates can mail resumes at priya.gupta1@hdfcergo.com