SBO

Health Insurance Claims - Processing Head

Bengaluru, Karnataka
Work Type: Full Time

 About Navi
Navi is one of the fastest growing financial services companies in India providing Personal &
Home Loans, Insurance and Mutual Funds with a digital first approach. At Navi, our mission
is to build financial services that are simple, accessible and affordable.

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

About the role:
At Navi, our high-performance culture is based on open communication, cultivating
entrepreneurial mindsets, and being biased towards action and impact.
The candidate will be responsible for managing the health insurance claims processing end
to end. This includes leading the group of doctors and analysts to evaluate claims
documentation, verify decisions taken, deliver quality output, manage data, handle decision
discrepancies, ensure the customer centricity and collaborate with the relevant teams. The
candidate will also play a key role in identifying and preventing claims fraud.

Key Responsibilities:
1. Latest Medical Trends: Guide the team with evolving medical treatments, procedures,
and industry trends to ensure accurate assessment of claims based on current
medical knowledge.
2. Overseeing Claim Processes: Managing the end-to-end claim operations, ensuring
accuracy, efficiency, and compliance with regulations.
3. Team Management: Leading a team of claims processors, coordinators, and experts
to ensure prompt and fair claim settlements.
4. Quality Assurance: Implementing and maintaining quality assurance standards to
improve overall claim processing and minimize errors.
5. Analyzing Trends: Analyzing claim data to identify trends, patterns, and areas for
improvement in processes or policies.
6. Collaboration: Collaborating with other departments such as field investigation,
hospital partnership, customer experience, underwriting, finance, compliance and
escalations to streamline processes and enhance customer satisfaction.
7. Continuous Improvement: Implementing improvements in systems, technologies, and
procedures to enhance efficiency and accuracy in claims processing.
8. Compliance and Auditing: Ensuring regulatory compliance, reporting and conducting
regular audits to maintain accuracy and integrity in claims handling.
9. Reporting: Preparing and publishing reports and presentations
We are looking for some self starters with exceptional subject matter knowledge who love
getting their hands dirty and building industry first things ground up.

Mode: On-site - Navi Office (Bengaluru)

Profile & Competency Pointers:
● Manage a set of Team members
● Have deep understanding of medical terminology, procedures, diagnoses, and treatments
● Entrepreneurial mind-set along with an ability to hustle and solve problems on-ground
● A bright and strategic mindset, with a well-honed eye for detail, comfortable with data
● Excellent communication and interpersonal skills with a collaborative management style
● Product Thinking

Preferred Qualifications:
Educational Background:
● Mandatory requirement - MBBS (Registered with MCI) from top tier college
● Good to have - MD or MBA/PGDM from Tier-1/Tier-2 B-Schools
Experience:
● Should have 5 to 10 years of recent clinical experience.
● Providing medical care to patients: This may include conducting physical exams,
diagnosing illnesses, prescribing medications, and recommending treatments.
● Managing patient care: This may include coordinating care with other healthcare
providers, monitoring patient progress, and educating patients about their condition.
● Advocate for patients: This may include working with patients to ensure that they
receive the care they need, or advocating for policies that improve the healthcare
system.
● Good to have previous experience in health insurance

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