About the Team

The Claims team at Navi is responsible for delivering a quick, transparent, and customer-first claims experience. From initial intimation to final settlement whether cashless or reimbursement they manage the end-to-end process with a solid focus on accuracy and turnaround time. The team works closely with the Hospital Partnerships team to streamline coordination and uses data-driven insights and process automation to improve claim resolution speed and customer satisfaction.

About the Role

The role involves end-to-end medical claims adjudication, including reviewing treatment records, verifying eligibility, identifying potential fraud, and making informed claim decisions. It requires coordination with providers, customers, and internal stakeholders to ensure TAT and SLA adherence. The Medical Officer is also expected to support cost negotiations and assist in claim analytics. Robust communication, regulatory knowledge, and problem-solving skills are essential, along with a background in medicine.

What We Expect From You




Reviewing and evaluating medical claims to determine their eligibility for payment
Investigating medical claims to identify fraud
Communicating with claimants, providers, and other parties involved in the claim
Making decisions about medical claims, such as whether to approve or deny a claim
Negotiate with the treating doctor/ hospital to reduce the unjustified hospitalization cost
Automate the system and bring in improvements on claims processes
Monitoring systems and processes to ensure sustained levels of performance
Liaison with internal stakeholders to ensure the deadlines of TAT’s and SLA’s & work towards Designated Tasks
Tracking of customer communication for effective grievance resolution within TAT & SLA’s
Knowledge of products, regulations, and guidelines is a must to ensure process compliance.
Claim Analytics- Periodical claim analysis to identify frauds, monitor claim performance metrics.
Informin

📌 Medical Officer Bengaluru (India)
🏢 Navi
📍 India