Clinical Investigator

UnitedHealth Group; Hyderabad; On-site; INR 900,000 - 1,500,000; Full time

Job summary

UnitedHealth Group in Hyderabad, India seeks a Clinical Investigator to support medical coding and fraud prevention across plans and claims. The role emphasizes CPT/ICD coding accuracy, regulatory compliance, and collaboration on special projects with cross-functional teams.

The candidate should have a medical or allied health background with CPC certification and 1+ years of coding experience. Strong attention to detail and commitment to quality are essential for success.

Qualifications

• Graduation - Any Graduate, BHMS/BAMS/BUMS/BPT/MPT (preferred)
• B.Sc. Nursing and BDS with 1+ years of corporate experience
• Certified coder through AAPC
• Certifications accepted - CPC Only
• 1+ years of experience (if not medical graduate) - specialty coding such as E&M, surgery, anesthesia etc., but not only HCC
• Extensive work experience within own function
• Proven attention to detail & Quality focused

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 all applicable Company policies, procedures, and business directives, changes including those relating to work location, team assignments, work schedules, and flexible work arrangements.

Skills

Attention to detail

Medical coding knowledge

Compliance awareness

CPT/ICD coding familiarity

Auditing / fraud prevention

Team coordination

Education

BHMS/BAMS/BUMS/BPT/MPT

B.Sc. Nursing and BDS with 1+ years of corporate experience

AAPC CPC Certification

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Clinical Investigator (2397884)

Clinical Investigator - 2397884

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

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 all applicable Company policies, procedures, and business directives, changes including those relating to work location, team assignments, work schedules, and flexible work arrangements.

Required Qualifications:

• Graduation - Any Graduate, BHMS/BAMS/BUMS/BPT/MPT (preferred)
• B.Sc. Nursing and BDS with 1+ years of corporate experience
• Certified coder through AAPC
• Certifications accepted - CPC Only
• 1+ years of experience (if not medical graduate) - specialty coding such as E&M, surgery, anesthesia etc., but not only HCC
• Extensive work experience within own function
• Proven attention to detail & Quality focused

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.

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.