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Medical Officer

2 weeks ago

Bengaluru, Karnataka, India Navi Full time ₹ 1,04,000 - ₹ 1,30,878 per year
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
●  Review submitted health claims for accuracy, completeness, and compliance with insurance policies and applicable regulations.
●  Reviewing  and  evaluating  medical  claims  to  determine  their  eligibility  for  payment,  and investigating medical claims to identify fraud.
●  Making decisions about medical claims, such as whether to approve or deny a claim  
●  Liaison with internal stakeholders to ensure the deadlines of TAT's and SLA's & Work towards designated tasks.
●  Claim  Analytics-  Periodical  claim  analysis  to  identify  frauds,  monitor  claim  performance
metrics.  
●  Informing the customer about the rejection of their claim through a call.

Must Haves
●  The role involves identifying discrepancies, fraud, or errors in claims to ensure
compliance with health insurance policies and regulatory requirements.
●  Ability to handle independent assignments & having the acumen to draw 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, IRDA circulars is a must.  
●  Knowledge of different languages would be an added advantage. Proficiency in
Hindi and English is mandatory.
●  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.
●  Candidates having data analytics experience would be an added advantage.
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.