Medical Officer-(Medical Claim Adjudication)
Job details
About Navi: Navi is one of the fastest-growing financial services companies in India providing Personal & Home Loans, UPI, Insurance, Mutual Funds, and Gold. Navi's mission is to deliver digital-first financial products that are simple, accessible, and affordable. Drawing on our in-house AI/ML capabilities, technology, and product expertise, Navi is dedicated to building delightful customer experiences. Founders: Sachin Bansal & Ankit Agarwal Know what makes you a “Navi_ite” : 1. Perseverance, Passion and Commitment • Passionate about Navi’s mission and vision • Demonstrates dedication, perseverance, and high ownership • Goes above and beyond by taking on additional responsibilities 2. Obsession with high-quality results • Consistently creates value for the customers and stakeholders through high-quality outcomes • Ensuring excellence in all aspects of work • Efficiently manages time, prioritizes tasks, and achieves higher standards 3. Resilience and Adaptability • Adapts quickly to new roles, responsibilities, and changing circumstances, showing resilience and agility What would your role at Navi look like?
- 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 in reducing the un-justified hospitalization cost
- Automate system and bring in improvements on claims processes
- Monitoring systems and processes to ensure sustained levels of performance
- Liaison with internal stakeholder to ensure the deadline of TAT’s and SLA’s & Work towards Designated Tasks
- Tracking of customer communication for effective grievance resolution within TAT & SLA’s
- Compliance- Through knowledge of products, regulations, guidelines is must to ensure process compliance all the time.
- Claim Analytics- Periodical claim analysis to identify frauds, monitor claim performance metrics.
- Informing the customer about the rejection of their claim through call.
- Team Management- Build and manage the team of processing doctors supporting the
- function
- Ability to handle independent assignments & having the acumen to take 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.
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