Senior Claims Manager

About the TeamThe Process Excellence team at Navi is focused on maintaining and elevating the quality of customer interactions. As the quality audit function, the team conducts regular audits of agent communications—across calls, chats, and other channels—to ensure accuracy, consistency, and compliance. The team also ensures compliance across different verticals and runs multiple initiatives in coordination with business team stakeholders to drive key business metrics. Insights from these audits are used to drive continuous improvement through targeted training, helping agents close knowledge or process gaps and deliver a consistently excellent customer experience.About the RoleWe are seeking an experienced doctor with medical knowledge, analytical skills for process excellence to join our dynamic team..The ideal candidate will be responsible for strategic claim auditing, insight-driven reporting, stakeholder engagement, and improvement areas. The auditor should be able to identify patterns and process gaps. will collaborate with cross-functional teams like claims, network providers, and investigations. product, analytics, automation & compliance to ensure successful delivery of initiatives.What We Expect From YouReview submitted health claims for accuracy, completeness, and compliance with insurance policies and applicable regulations.Identify any inconsistencies, overbilling, or discrepancies between services provided and the claims submittedDetect potential fraudulent claims by analyzing patterns and identifying suspicious activities or behaviorsProviding detailed reports on audit findings, Decision accuracy, including identifying overpayments, underpayments, or fraudulent activitiesRecommend actions based on findings, such as denying, reducing, or adjusting claimsCommunicate audit results and findings to management and external stakeholdersReview submitted health claims for accuracy, completeness, and compliance with insurance policies and applicable regulations.Identify any inconsistencies, overbilling, or discrepancies between services provided and the claims submittedDetect potential fraudulent claims by analyzing patterns and identifying suspicious activities or behaviorsProviding detailed reports on audit findings, Decision accuracy, including identifying overpayments, underpayments, or fraudulent activitiesRecommend actions based on findings, such as denying, reducing, or adjusting claimsCommunicate audit results and findings to management and external stakeholdersMust HavesMedical Graduate in any stream (MBBS/BHMS/BAMS/BUMS/BDS)Experience in handling auditBackground in claims processing with clinical experience in a hospital settingData analytics experience would be an added advantageKnowledge of different languages would be an added advantage. Proficiency in Hindi and English is mandatory.Knowledge of health insurance policies and regulations, IRDAI circulars is mustStrong analytical and problem-solving skills.Excellent attention to detail and ability to spot discrepanciesAbility to anticipate potential problems and take appropriate corrective actionEffective communication skills for working with different stakeholdersTime management skills to meet deadlines.Should have a broad understanding of Claims PracticeSharp business acumen to understand health insurance claim servicing needsExcellent communication skills, including writing reports and presentationsInside NaviWe are shaping the future of financial services for a billion Indians through products that are simple, accessible, and affordable. From Personal & Home Loans to