The operating efficiency of high-head pump turbines is closely related to the internal hydraulic losses within the system. Conventional methods for calculating hydraulic losses based on pressure differences often lack detailed information on their distribution and specific sources. Additionally, the presence of splitter blades further complicates the hydraulic loss characteristics, necessitating further study. In this study, Reynolds-averaged Navier–Stokes (RANS) simulations were employed to analyze the performance of a pump turbine with splitter blades at three different head conditions and a guide vane opening (GVO) of 10°. The numerical simulations were validated by experimental tests using laser doppler velocimetry (LDV). Quantitative analysis of flow components and hydraulic losses was conducted using entropy production theory in combination with an examination of flow field distributions to identify the origins and features of hydraulic losses. The results indicate that higher heads are associated with lower growth rates of total hydraulic losses. In particular, the significant velocity gradients at the trailing edge of the splitter blades contribute to higher hydraulic losses. Furthermore, the hydraulic losses in the runner (RN) region are predominantly influenced by velocity gradients and not by vortices, with the flow conditions in the RN region impacting the hydraulic losses in the draft tube (DT).