Clinical Investigator

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Job Description

Positions in this function are responsible for investigating, recovering and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities. May include initiating telephone calls to members, providers and other insurance companies to gather coordination of benefits data. Investigate and pursue recoveries and payables on subrogation claims and file management. Process recovery on claims. Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance. May conduct contestable investigations to review medical history. May monitor large claims including transplant cases.

• Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/diagnosis codes, CMC guideline along with referring to client specific guidelines and member policies.
• Adherence to state and federal compliance policies and contract compliance.
• Assist the prospective team with special projects and reporting.
• Work is frequently completed without established procedures.
• Works independently.
• May act as a resource for others.
• May coordinate others activities.
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives.

• Medical degree BHMS/BAMS/BUMS/BPT/MPT B.Sc Nursing and BDS with 1 year of corporate experience.
• Experience Range 06 months 3 years (Freshers in BPT / MPT / BHMS/ BAMS/ BUMS can also apply).
• Extensive work experience within own function.
• Proven attention to detail & Quality focused.
• Proven good Analytical & comprehension skills.

• Claims processing experience.
• Health Insurance knowledge, managed care experience.
• Knowledge of US Healthcare and coding.
• Medical record familiarity.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone of every race, gender, sexuality, age, location and income deserves the opportunity to live their healthiest life. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes.

Apply Internal Employee Application Locations - Primary Location: Noida, Uttar Pradesh, IN

• Job Function: Doctors/Nurses/Medical Professional
• Specialization: Admin Services/Medical Facilities
• Industry: Healthcare Services (Other Healthcare Services)