Medical Officer

1 month ago

bangalore, 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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