Medical Officer - Claim Escalation

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 settlementwhether cashless or reimbursementthey 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

We are seeking a dedicated and compassionate Medical Officer to join our De-Escalation Team. This role will involve managing & mitigating escalated claim-related issues, with a focus on handling sensitive customer interactions in a calm and empathetic manner. The Medical Officer will work closely with customer service, claims teams, and healthcare professionals to provide expert medical advice and support in resolving claims disputes. The ideal candidate will have strong

communication skills, a deep understanding of medical protocols and insurance claims, and the ability to help diffuse complex situations.

What We Expect From You

Medical Expertise in Claims Escalation

Provide clinical expertise and insight into escalated claims, particularly where medical treatment, procedures, or diagnoses are involved. Review and assess the medical aspects of claims to ensure they align with policy coverage.

De-escalation of customer issues

Serve as the primary contact for escalated customer claims and concerns, responding with calm empathy, addressing issues diplomatically, and ensuring satisfaction while adhering to company policies

De-escalation of customer issues and conflict Resolution through internal collaboration

Be the voice of the customer in Navi and work closely with the claims processing and other related teams to ensure smooth resolution of escalated cases.

Rejection Call Handling

Manage rejection calls with empathy, clearly explaining the reasons behind claim rejections and offering guidance on next steps

Customer Experience & Retention

Enhance the overall customer experience by demonstrating patience, empathy, and understanding, and provide clear, understandable, & compassionate communication to customers regarding the claim

Must Haves

• Ability to grasp the domain quickly and develop business insights
• Exceptional communication skills (Oral and Verbal)
• Proactive in identifying potential issues and implementing the necessary corrective measures.
• Strong stakeholder management to drive
• Excellent logical reasoning skills
• Prior experience managing escalations is preferred.
• Previous experience of working in hospitals or insurance health claims is advantageous
• Medical Graduate in any stream (MBBS/BHMS/BAMS/BUMS/BDS)
• Knowledge of additional languages is a plus, with proficiency in Hindi and English being essential.

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 Indias fastest-growing financial services organisations. But were just getting started!

To know more about us, our work, people, culture, values, etc., check out navi.com/careers.

Our Culture

At Navi, were 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 youre 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.

Were 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/our-values to see what drives us every day.

If this feels like you, Navi is the place to grow, thrive and make a real impact.