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 teamThe 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.

Location: bangalore, IN

Posted Date: 6/17/2025