Field Investigation Officer
3 weeks ago
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
What would your role at Navi Look Like?
- Conduct on-ground field investigations across Hospitals, policyholders' locations and related places to gather information and evidence related to health insurance claims. This may include reviewing medical records, interviewing claimants, hospital/ Laboratory/ Pharmacy staff, and inspecting the circumstances surrounding the claim.
- Assess the validity of claims by verifying the accuracy of medical documentation, treatment plans, and billing information.
- Investigate claims suspected of fraudulent activity or misrepresentation. Identify red flags, inconsistencies, or patterns that warrant further scrutiny.
- Maintain detailed records of field investigations, including observations and collected evidence. Prepare a comprehensive report of every case by summarizing findings, analysis, and recommendations for claims adjudication.
- Submit the investigation findings through reporting, within the allotted time period.
- Coordinate with the internal team to share insights and findings that contribute to informed claims decisions.
What are some good to have skills for this role?
- On-field Execution Experience - Field/On ground experience in insurance or medical or related fields
- Analytical thinking - ability to critically assess information, recognize patterns and draw a logical conclusion
- Attention to details - thoroughness in reviewing the documents, identifying the discrepancies and ensuring the accuracy of the process
- Good understanding of insurance claim processing and Health Claim Investigation process
- Good understanding of the hospitalization process, different departments of hospital and basic knowledge of medical ailments would be preferred
- Excellent communication skills, including writing emails and good command on MS Excel
- Ability to work collaboratively with internal teams
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