Senior 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, analytical skills for process excellence to join our dynamic team..The ideal candidate will be responsible for strategic claim auditing, insight-driven reporting, stakeholder engagement, and improvement areas. The auditor should be able to identify patterns and process gaps. will collaborate with cross-functional teams like claims, network providers, and investigations. product, analytics, automation & compliance to ensure successful delivery of initiatives.

What We Expect From You

Review submitted health claims for accuracy, completeness, and compliance with insurance policies and applicable regulations.

Identify any inconsistencies, overbilling, or discrepancies between services provided and the claims submitted

Detect potential fraudulent claims by analyzing patterns and identifying suspicious activities or behaviors

Providing detailed reports on audit findings, Decision accuracy, including identifying overpayments, underpayments, or fraudulent activities

Recommend actions based on findings, such as denying, reducing, or adjusting claims

Communicate audit results and findings to management and external stakeholders

Review submitted health claims for accuracy, completeness, and compliance with insurance policies and applicable regulations.

Identify any inconsistencies, overbilling, or discrepancies between services provided and the claims submitted

Detect potential fraudulent claims by analyzing patterns and identifying suspicious activities or behaviors

Providing detailed reports on audit findings, Decision accuracy, including identifying overpayments, underpayments, or fraudulent activities

Recommend actions based on findings, such as denying, reducing, or adjusting claims

Communicate audit results and findings to management and external stakeholders

Must Haves

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

Experience in handling 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 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 UPI, Insurance, Mutual Funds, and Gold — we’re building tech-first solutions that work at scale, with a strong customer-first approach.

Founded by Sachin Bansal & Ankit Agarwal in 2018, we are one of India’s

fastest-growing financial services organisations. But we’re just getting started!

Our Culture

The Navi DNA

Ambition. Perseverance. Self-awareness. Ownership. Integrity.

We’re looking for people who dream big when it comes to innovation. At Navi, you’ll be empowered with the right mechanisms to work in a dynamic team that builds and improves innovative solutions. If you’re driven to deliver real value to customers, no matter the challenge, this is the place for you. We chase excellence by uplifting each other—and that starts with every one of us.

Why You'll Thrive at Navi

At Navi, it’s about how you think, build, and grow. You’ll thrive here if :

You’re impact-driven

: You take ownership, build boldly, and care about making a real difference.

You strive for excellence

: Good isn’t good enough. You bring focus, precision, and a passion for quality.

You embrace change

: You adapt quickly, move fast, and always put the customer first.