Claims Manager

About the Team
The  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 Role
We are seeking an experienced doctor with medical knowledge for the process excellence vertical to
join our dynamic team.  As a vital member of our Process Excellence team, a quality auditor dedicated
exclusively  to  auditing  claims  processed  by  medical  officers  to  ensure  accuracy,  compliance,  and
continual improvement. A quality auditor conducts detailed reviews of claims, identifying areas for
improvement..
What We Expect From You
●  The role involves identifying discrepancies, fraud, or errors in claims to ensure
compliance with health insurance policies and regulatory requirements  
●  Review  health  claims  for  accuracy,   completeness,  and  compliance  with
insurance policies and applicable regulations.  
●  Identify any inconsistencies, overbilling, or discrepancies between the services
provided and the claims submitted  

●   Detect   potential   fraudulent   claims  by  analyzing  patterns  and  identifying  
suspicious  activities  or behaviors  
●  Suggest process improvements to enhance the efficiency and accuracy of the
claims audit process.  
●  Stay  updated  with  industry  trends,  regulations,  and  changes  in  healthcare
policies that may impact claims auditing.

Must Haves

●  Medical Graduate in any stream (MBBS/BHMS/BAMS/BUMS/BDS)  
●  Experience in handling an audit  
●  Background in claims processing with clinical experience in a hospital setting  
●  Data analytics experience would be an added advantage  
●  Knowledge 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 a must  
●  Strong analytical and problem-solving skills.  
●  Excellent attention to detail and ability to spot discrepancies  
●  Ability to anticipate potential problems and take appropriate corrective action  
●  Effective communication skills for working with different stakeholders  
●  Time management skills to meet deadlines.  
●  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

Inside Navi
We  are  shaping the future of financial services for a billion Indians through products
that  are  simple,  accessible,  and  affordable.  From  Personal  &  Home  Loans  to  UPI,
Insurance, Mutual Funds, and Gold — we're building tech-first solutions that work at
scale, with a strong customer-first approach.  

Founded  by  Sachin  Bansal  &  Ankit  Agarwal  in  2018,  we  are  one  of  India's
fastest-growing financial services organisations. But we're just getting started
Our Culture
The Navi DNA  
Ambition. Perseverance. Self-awareness. Ownership. Integrity.
We're looking for people who dream big when it comes to innovation. At Navi, you'll be
empowered  with  the  right  mechanisms  to  work  in  a  dynamic  team  that  builds and
improves  innovative  solutions.  If  you're  driven to deliver real value to customers, no
matter the challenge, this is the place for you.
We chase excellence by uplifting each other—and that starts with every one of us.

Why You'll Thrive at Navi
At Navi, it's about how you think, build, and grow. You'll thrive here if:
●  You're impact-driven : You take ownership, build boldly, and care about making
a real difference.
●  You strive for excellence : Good isn't good enough. You bring focus, precision,
and a passion for quality.
●  You  embrace  change  :  You  adapt  quickly,  move  fast,  and  always  put  the
customer first.

---