Medical Officer

1 month ago

Bangalore Urban, India Navi Full time

About Navi

Navi is one of the fastest-growing financial services companies in India providing Personal & Home Loans, UPI, Insurance, Mutual Funds, and Gold. Navi's mission is to deliver digital-first financial products that are simple, accessible, and affordable. Drawing on our in-house AI/ML capabilities, technology, and product expertise, Navi is dedicated to building delightful customer experiences.


Founders: Sachin Bansal & Ankit Agarwal


Know what makes you a “Navi_ite” :

1.Perseverance, Passion and Commitment

• Passionate about Navi’s mission and vision

• Demonstrates dedication, perseverance and high ownership

• Goes above and beyond by taking on additional responsibilities


2.Obsession with high quality results

• Consistently creates value for the customers and stakeholders through high quality outcomes

• Ensuring excellence in all aspects of work

• Efficiently manages time, prioritizes tasks, and achieves higher standards


3.Resilience and Adaptability

• Adapts quickly to new roles, responsibilities, and changing circumstances, showing resilience and agility


Desirable Skills and Abilities:


  • Ability to handle independent assignments & having the acumen to take logical conclusions He/she should have a broad understanding of Claims Practice
  • Sharp business acumen to understand health insurance claim servicing needs
  • Excellent communication skills, including writing reports and presentations
  • Ability to anticipate potential problems and take appropriate corrective action
  • Knowledge of health regulations, IRDAI circulars is must


Desirable educational qualification & experience:


  • Medical Graduate in any stream (MBBS/BHMS/BAMS/BUMS/BDS)
  • Candidates having data analytics experience would be an added advantage



Role Responsibilities:

  • Reviewing and evaluating medical claims to determine their eligibility for payment
  • Investigating medical claims to identify fraud
  • Communicating with claimants, providers, and other parties involved in the claim
  • Making decisions about medical claims, such as whether to approve or deny a claim
  • Negotiate with the treating doctor/ hospital in reducing the un-justified hospitalization cost
  • Automate system and bring in improvements on claims processes
  • Monitoring systems and processes to ensure sustained levels of performance
  • Liaison with internal stakeholder to ensure the deadline of TAT’s and SLA’s & Work towards Designated Tasks
  • Tracking of customer communication for effective grievance resolution within TAT & SLA’s
  • Compliance- Through knowledge of products, regulations, guidelines is must to ensure process compliance all the time.
  • Claim Analytics- Periodical claim analysis to identify frauds, monitor claim performance metrics.
  • Team Management- Build and manage the team of processing doctors supporting the function

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