Senior 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, 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 You
●  Review 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 submitted
●  Detect   potential   fraudulent   claims   by   analyzing   patterns  and  identifying  
suspicious  activities or behaviors  
●  Providing  detailed  reports  on  audit  findings,  Decision  accuracy,  including  
identifying overpayments, underpayments, or fraudulent activities  
●  Recommend actions based on findings, such as denying, reducing, or adjusting
claims  
●  Communicate  audit  results  and  findings  to  management  and  external
stakeholders
●  Review  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 submitted  
●  Detect   potential   fraudulent   claims   by   analyzing   patterns  and  identifying  
suspicious activities or behaviors  
●  Providing   detailed   reports   on  audit  findings,  Decision  accuracy,    including  
identifying overpayments, underpayments, or fraudulent activities  
●  Recommend actions based on findings, such as denying, reducing, or adjusting
claims  
●  Communicate  audit  results  and  findings  to  management  and  external
stakeholders

Must Haves
●  Medical Graduate in any stream (MBBS/BHMS/BAMS/BUMS/BDS)  
●  Experience in handling 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 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.

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