Senior Associate II - Medical Officer - (Medical Claim Adjudication)

About the Team
The Claims team at Navi is responsible for delivering a fast, transparent, and
customer-first claims experience. From initial intimation to final settlement—whether
cashless or reimbursement—they manage the end-to-end process with a strong
focus on accuracy and turnaround time. The team works closely with the Hospital
partnerships team to streamline coordination and uses data-driven insights and
process automation to improve claim resolution speed and customer satisfaction.
About the Role
The role involves end-to-end medical claims adjudication, including reviewing treatment records,
verifying eligibility, identifying potential fraud, and making informed claim decisions. It requires
coordination with providers, customers, and internal stakeholders to ensure TAT and SLA adherence.
The Medical Officer is also expected to support cost negotiations and assist in claim analytics. Strong
communication, regulatory knowledge, and problem-solving skills are essential, along with a
background in medicine.
What We Expect From You
Reviewing and evaluating medical claims to determine their eligibility for payment.
Investigating medical claims to identify fraud.
Communicating with claimants, providers, and other parties involved in the claim.
Making decisions about medical claims, such as whether to approve or deny a claim.
Negotiate with the treating doctor/ hospital to reduce the unjustified hospitalization cost.
Automate the system and bring in improvements on claims processes.
Monitoring systems and processes to ensure sustained levels of performance.
Liaison with internal stakeholders to ensure the deadlines of TAT’s and SLA’s & Work towards designated tasks.
Tracking of customer communication for effective grievance resolution within TAT & SLA’s.
Knowledge of products, regulations, and guidelines is a must to ensure process compliance.
Claim Analytics- Periodical claim analysis to identify frauds, monitor claim performance metrics.
Informing the customer about the rejection of their claim through a call.
Team Management - Build and manage a team of processing doctors to support the function.
Must Haves
Ability to handle independent assignments & having the acumen to draw logical conclusions.
He/she 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.
Ability to anticipate potential problems and take appropriate corrective action.
Knowledge of health regulations, IRDA circulars is a must.
Medical Graduate in any stream (MBBS/BHMS/BAMS/BUMS/BDS)
Candidates having data analytics experience would be an added advantage.
Knowledge of different languages would be an added advantage. Proficiency in Hindi and English is mandatory.
About Navi
We are on a mission to make finance simple, accessible and affordable for a billion
Indians. Guided by a strong customer-first approach, we are building tech-first solutions that work at scale. Our offerings include a range of financial products and services across Loans, Insurance, Mutual Funds, Digital Gold and UPI.
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! To know more about us, our work, people, culture, values etc., check out navi.com/careers.
Our Culture
At Navi, we’re a place where ambition meets opportunity and ideas turn into impact quickly. We empower people with high ownership from the start, encouraging them to solve meaningful problems and build with excellence. Teams here work in an environment that values speed, collaboration and craftsmanship, while celebrating learning, growth and shared wins along the way. Whether you’re shaping the future of fintech products or driving innovation behind the scenes, life at Navi means being part of a high-energy, talent-driven workplace where your contributions truly make a difference.
We’re guided by our own operating system - The Navi OS - a set of principles that shape how we work and win together. You can explore them at navi.com/careers/values-at-navi to see what drives us every day.
If this feels like you, Navi is the place to grow, thrive and make a real impact.

Work arrangement
No