Claims manager - medical claim audit

About the Team

The Process Excellence team at Navi is focused on maintaining and elevating the quality of customer interactions. As the quality audit function, the team conducts regular audits of agent communications—across calls, chats, and other channels—to ensure accuracy, consistency, and compliance. The team also ensures compliance across different verticals and runs multiple initiatives in coordination with business team stakeholders to drive key business metrics. Insights from these audits are used to drive continuous improvement through targeted training, helping agents close knowledge or process gaps and deliver a consistently excellent customer experience.

About the Role

We are seeking an experienced doctor with medical knowledge for the process excellence vertical to join our dynamic team. As a vital member of our Process Excellence team, a quality auditor dedicated exclusively to auditing claims processed by medical officers to ensure accuracy, compliance, and continual improvement. A quality auditor conducts detailed reviews of claims, identifying areas for improvement.

What We Expect From You

The role involves identifying 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 any inconsistencies, overbilling, or discrepancies between the services provided and the 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 that may impact claims auditing.

Must Haves

Medical Graduate in any stream (MBBS / BHMS / BAMS / BUMS / BDS)

Experience in handling an audit

Background in claims processing with clinical experience in a hospital setting

Data analytics experience would be an added advantage

Knowledge of different languages would be an added advantage. Proficiency in Hindi and English is mandatory.

Knowledge of health insurance policies and regulations, IRDAI circulars is a must

Strong analytical and problem-solving skills.

Excellent attention to detail and ability to spot discrepancies

Ability to anticipate potential problems and take appropriate corrective action

Effective communication skills for working with different stakeholders

Time management skills to meet deadlines.

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

Inside Navi

We are shaping the future of financial services for a billion Indians through products that are simple, accessible, and affordable. From Personal & Home Loans to