Senior Executive - Risk and Loss Mitigation

About the role

Physical field Investigation of claim assignedthrough system. Ascertain evidence quality as per matrix Validate each & every evidence with the case triggers Identification of Hospitals/ individuals involved in malpractices to create database Escalation &Grievance Management for the investigated cases

What you'll do

• Report submission in CIMA (In house system that is being usedfor Investigation)
• Maintain healthy and cordial relationship with hospitals and TPA desk
• Ensure the ethics and compliance while investigating a claim
• Analyze data on utilization, outcomes to determine trends and identify problem areas
• Filing of police complaints and liaising with the police authorities for taking necessary action against fraudulent individuals / hospital and others

What you need

• 3–6 yrs of experience
• Claims processing
• Excel
• Insurance
• MIS reporting
• Reconciliation
• Compliance
• BDS