Field Investigation Officer
1 month ago
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 fieldsAnalytical thinking - ability to critically assess information, recognize patterns and draw a logical conclusionAttention to details - thoroughness in reviewing the documents, identifying the discrepancies and ensuring the accuracy of the processGood understanding of insurance claim processing and Health Claim Investigation processGood understanding of the hospitalization process, different departments of hospital and basic knowledge of medical ailments would be preferredExcellent communication skills, including writing emails and good command on MS ExcelAbility to work collaboratively with internal teams
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