Job Description

What Were Looking For: Were seeking a motivated Medical Officer with expertise in medical claim adjudication to join our dynamic team. If you have a medical background, a keen understanding of claims processes, and a passion for delivering high-quality results, we want to hear from you! Responsibilities: Review and evaluate medical claims to determine payment eligibility. Investigate claims for potential fraud and ensure compliance with IRDA regulations and guidelines. Communicate effectively with claimants, providers, and other stakeholders regarding claims decisions. Negotiate with treating doctors/hospitals to reduce unjustified hospitalization costs. Drive improvements and automation in claims processes. Monitor systems and processes to maintain high performance standards. Ensure adherence to TATs (Turnaround Times) and SLAs (Service Level Agreements) in collaboration with internal teams. Resolve customer grievances efficiently within stipulated timelines. Analyze claims data to identify trends, fraud patterns, and optimize performance metrics. Inform customers about claim rejections via direct communication. Build and manage a team of processing doctors to support claims operations. Qualifications: Medical Graduate (MBBS/BHMS/BAMS/BUMS/BDS). Proficiency in English and Hindi; additional languages are an advantage. Strong understanding of claims processes, health regulations, and IRDA guidelines. Excellent communication, analytical, and problem-solving skills. Experience in data analytics is a plus. Ability to manage independent assignments and deliver results under tight deadlines. Why Join Us? At Navi, youll become a Navi_ite if you exhibit: Perseverance, Passion, and Commitment Dedication to our mission and high ownership of responsibilities. Obsession with Quality Delivering value through consistent, high-quality outcomes. Resilience and Adaptability Thriving in dynamic environments and embracing challenges with agility. What We Offer: An opportunity to work with one of Indias leading financial services companies. A chance to make a meaningful impact on the health insurance sector. A collaborative and growth-oriented work environment.