Assistant Investigation Manager

Job highlights

• BHMS/BDS/BAMS/BUMS with 4-6 years in TPA/Health Insurance investigations and expertise in fraud detection
• Lead investigation of suspicious high-value health insurance claims, conduct audits, review medical documents, coordinate with stakeholders, and manage investigation team

Vidal Health Insurance TPA is looking for Assistnat Manager for Investigation dpt

Location:Gurgaon,Udhyog Vihar Phase 5
Experience: 4-6 Years

Qualifications

• BHMS/BDS/BAMS/BUMS

Role Overview

We are looking for an experienced professional to lead the Investigation function within a Health Insurance TPA environment. The role involves handling suspicious and high-value claims, identifying fraud patterns, and ensuring effective risk control.

Key Responsibilities

• Lead investigation of suspicious and high-value health insurance claims
• Identify fraud patterns (inflated billing, unnecessary hospitalization, document manipulation, etc.)
• Conduct hospital audits and field investigations
• Review medical records, bills, and claim documents for discrepancies
• Coordinate with hospitals, insurers, and internal teams
• Prepare investigation reports with findings and recommendations
• Ensure compliance with IRDAI guidelines and internal processes
• Track MIS, dashboards, and fraud trends
• Manage and guide investigation team members

Key Requirements

• Strong knowledge of health insurance claims (cashless & reimbursement)
• Experience in fraud detection and hospital/provider investigations
• Understanding of medical billing and documentation
• Good analytical and report-writing skills
• Strong stakeholder management skills

Qualifications

• BHMS/BDS/BAMS/BUMS
• 4-6 years of experience in TPA / Health Insurance investigations

Why Join Us

• Opportunity to work in a critical risk control function
• Exposure to complex and high-impact cases
• Leadership role with team management responsibility