SBO

Medical Officer - Claim Investigations

Bengaluru, Karnataka
Work Type: Full Time

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


What would your role at Navi Look Like?
● Review and Evaluate Medical claim: Thoroughly examine medical claims to identify potential trigger points indicative of fraudulent activity.
● Plan the field investigation: Develop comprehensive strategies and plans for conducting field investigations and share it with field investigators
● Team Management: Provide leadership and guidance to the field investigation team to effectively identify and address potential fraud.
● Discussion with the Medical Staff: Engage in discussions with treating physicians and relevant medical personnel to gain insights and clarification on medical aspects of claims.
● Training: Conduct periodic training sessions for the field investigation team to enhance their skills and knowledge in detecting fraudulent activities.
● Data Analysis: Analyze the data and make informed decisions regarding further actions.
● Conduct Field Investigation: Execute field investigations as necessary, working alongside field investigators to gather evidence and information.
● Stakeholder Management: Collaborate with different stakeholders.


What are some good to have skills for this role?
● Medical Graduate in any stream (MBBS/BHMS/BAMS/BUMS/BDS) 
● People Management: Able to collaborate and communicate effectively with different teams
● Process Acumen: Ability to handle independent assignments & have the acumen to take logical conclusions
● Attention to Details: Thoroughness in reviewing the claim documents, insurance policies, and investigation process to ensure accuracy
● Critical Thinking: Capacity to assess the appropriateness and necessity of medical treatments and procedures based on established guidelines.
● Problem-Solving: Aptitude for identifying challenges, developing innovative solutions, and implementing strategies to mitigate risks and prevent fraudulent activities
● Communication: Excellent communication skills, including writing reports and presentations
● Candidates having data analytics experience would be an added advantage




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