Medical Job Opportunity in Medical Claim Audit at Navi
Medical Job opportunities at Navi include the Claims Manager – Medical Claim Audit role, designed for medical graduates looking for non-clinical career paths. This role is suitable for candidates exploring Navi jobs, MBBS jobs, and BDS jobs in the health insurance and claims audit domain.
Job Title: Claims Manager – Medical Claim Audit
About the Company
Navi is on a mission to make finance simple, accessible, and affordable for a billion Indians. Guided by a strong customer-first approach, Navi is building tech-first solutions that work at scale. The offerings include a range of financial products and services across Loans, Insurance, Mutual Funds, Digital Gold, and UPI. Founded by Sachin Bansal & Ankit Agarwal in 2018, Navi is one of India’s fastest-growing financial services organisations. Navi jobs span multiple domains, including insurance-focused medical job roles for healthcare professionals.
Qualifications
- Medical Graduate in any stream (MBBS / BUMS / BDS)
- Experience in handling an audit
- Background in claims processing with clinical experience in a hospital setting
- Data analytics experience is an added advantage
- Knowledge of different languages is an added advantage
- Proficiency in Hindi and English is mandatory
- Knowledge of health insurance policies, regulations, and IRDAI circulars
- Strong analytical and problem-solving skills
- Excellent attention to detail and ability to spot discrepancies
- Ability to anticipate potential problems and take corrective action
- Effective communication skills for working with stakeholders
- Strong time management skills
- Broad understanding of claims practice
- Sharp business acumen to understand health insurance claim servicing needs
- Excellent communication skills, including report and presentation writing
Job Description
This medical job is part of the Process Excellence team at Navi. The Process Excellence team focuses on maintaining and elevating the quality of customer interactions by conducting regular audits of agent communications and claims processing to ensure accuracy, consistency, and compliance. The Claims Manager – Medical Claim Audit role requires an experienced doctor with medical knowledge to function as a quality auditor dedicated exclusively to auditing claims processed by medical officers. This medical job is well-suited for professionals seeking MBBS jobs or BDS jobs outside hospital practice.
Key Responsibilities
- Identify discrepancies, fraud, or errors in claims to ensure compliance with health insurance policies and regulatory requirements
- Review health claims for accuracy, completeness, and compliance with insurance policies and applicable regulations
- Identify inconsistencies, overbilling, or discrepancies between services provided and claims submitted
- Detect potential fraudulent claims by analyzing patterns and identifying suspicious activities or behaviors
- Suggest process improvements to enhance the efficiency and accuracy of the claims audit process
- Stay updated with industry trends, regulations, and changes in healthcare policies impacting claims auditing
