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    Health Claim Investigation Officer - Thane, India - Navi

    Navi
    Navi Thane, India

    3 days ago

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    Description

    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?

    1.Conduct on-site visits to Hospitals, policyholders' locations and related places to gather information and evidence related to health insurance claims.

    2.Review medical records, interviewing claimants, hospital/ Laboratory/ Pharmacy staff, and inspecting the circumstances surrounding the claim.

    3.Assess the validity of claims by verifying the accuracy of medical documentation, treatment plans, and billing information.

    4.Investigate claims suspected of fraudulent activity or misrepresentation. Identify red flags, inconsistencies, or patterns that warrant further scrutiny.

    5.Prepare a comprehensive report of every case by summarizing findings, analysis, and recommendations for claims adjudication.

    6.Submission of the investigation findings within the allotted time period.

    7.Coordinate with the internal team to share insights and findings that contribute to informed claims decisions.

    What are some good to have skills for this role?

    1.Analytical thinking - ability to critically assess information, recognize patterns and draw a logical conclusion

    2.Attention to details - thoroughness in reviewing the documents and identifying the discrepancies

    3.Good understanding of insurance process

    4.Excellent communication skills, including writing emails and good command on MS Excel

    5.Ability to work collaboratively with internal teams

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