Medical Officer - (Medical Claim Adjudication)

About the Team

The Claims team at Navi is responsible for delivering a fast, 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 strong focus on accuracy and turnaround time. The team works closely with the Hospital Partnerships team to streamline coordination and use 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. Strong 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 to claims processes
• Monitoring systems and processes to ensure sustained levels of performance
• Liaison with internal stakeholders to ensure the deadlines of TATs and SLAs & Work towards the designated Tasks
• Tracking of customer communication for effective grievance resolution within TAT & SLAs
• Knowledge of products, regulations, and guidelines is a must to ensure process compliance.
• Claim Analytics- Periodical claim analysis to identify fraud and monitor claim performance metrics.
• Informing the customer about the rejection of their claim through a call
• Team Management- Build and manage a team of processing doctors supporting the function

Must Haves

• 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.
• Medical Graduate in any stream (MBBS/BHMS/BAMS/BUMS/BDS)
• Candidates having data analytics experience would be an added advantage.
• Knowledge of different languages would be an added advantage. Proficiency in Hindi and English is mandatory.

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 are 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 are just getting started!

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Our Culture

The Navi DNA

Ambition. Perseverance. Self-awareness. Ownership. Integrity.

We are 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 otherand 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:

• Youre 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.