Clinical Investigator

Optum; Hyderabad; On-site; INR 450,000 - 650,000; Full time

Job summary

Optum in Hyderabad, India seeks a medical claims professional to prevent fraudulent and abusive claims using CPT/diagnosis knowledge and CMS guidelines. You will ensure compliance with state and federal policies and support reporting while coordinating with the team to share process updates.

CPC certification and a medical degree with 6+ months of experience are required. Strong attention to detail and the ability to work independently are essential.

Qualifications

• Medical degree (BHMS/BAMS/BUMS/BPT/MPT) and BSc Nursing or BDS.
• CPC Certification.
• 6+ months of experience; freshers in BPT/MPT/BHMS/BAMS/BUMS can apply.
• Extensive work experience within own function and strong attention to detail.

Responsibilities

• Prevent fraudulent/abusive claims using medical knowledge and coding guidelines.
• Adherence to state and federal compliance policies and contract compliance.
• Assist the team with special projects and reporting.
• Coordinate with team members and share new process updates.
• Comply with employment terms, policies, directives, and potential role changes.

Skills

Attention to detail

Analytical skills

Independent worker

CPC Certification

Education

BHMS/BAMS/BUMS/BPT/MPT

B.Sc Nursing

BDS

Job description

Primary Responsibilities:

• Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT or diagnosis codes, CMS 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
• Coordinate with all team members and share recent process related updates
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Qualifications - External

Required Qualifications:

• Medical degree - BHMS/BAMS/BUMS/BPT/MPT. B.Sc Nursing and BDS
• CPC Certification
• 6+ months of experience (Fresher''s 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
• Proven ability to work independently

Preferred Qualifications:

• 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. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.