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    Medical Officer - Bangalore Urban, India - Navi

    Navi
    Navi Bangalore Urban, India

    1 week 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

    Desirable Skills and Abilities:

    • 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, IRDAI circulars is must

    Desirable educational qualification & experience:

    • Medical Graduate in any stream (MBBS/BHMS/BAMS/BUMS/BDS)
    • Candidates having data analytics experience would be an added advantage

    Role 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 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.
    • Team Management- Build and manage the team of processing doctors supporting the function
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