Medical Officer Job at Navi | MBBS & BDS Jobs
Looking for a rewarding Medical Officer Job in the health insurance and financial services sector? Explore exciting opportunities with Navi, one of India’s fastest-growing fintech organizations. This role offers medical graduates a dynamic platform to work in medical claim adjudication, making it ideal for professionals seeking Navi jobs, MBBS jobs, or BDS jobs in a fast-paced, tech-driven environment.
Job Details:
- Job Position: Senior Associate II – Medical Officer (Medical Claim Adjudication)
- Location: India
About the Company
Navi is 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, the organization is building tech-first solutions that work at scale, with a strong customer-first approach. Founded by Sachin Bansal & Ankit Agarwal in 2018, Navi is one of India’s fastest-growing financial services organisations. The company continues to expand its offerings across Loans, Insurance, Mutual Funds, Digital Gold, and UPI while maintaining a strong focus on innovation and customer experience.
This Medical Officer Job is part of the growing portfolio of Navi jobs in the insurance and healthcare claims domain.
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.
This Medical Officer Job is suitable for candidates exploring Navi jobs in insurance claim management, particularly those searching for MBBS jobs or BDS jobs in the corporate healthcare sector.
Qualifications:
- 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/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.
Key Responsibilities:
- 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
