Clinical Investigator

Optum India; Hyderabad; On-site; INR 450,000 - 850,000; Full time

Job summary

UnitedHealth Group is seeking qualified medical coding professionals to prevent fraudulent or abusive claims using CPT/diagnosis codes and CMS guidelines. The role emphasizes compliance with contracts and company policies, while supporting the team with projects and reporting.

Candidates should have relevant medical degrees or certifications (CPC preferred) and experience in US healthcare coding, with strong attention to detail and analytical skills.

Qualifications

• Medical degree or allied health qualification as listed.
• CPC Certification or equivalent coding credential required.
• Experience with US healthcare coding and CPT/diagnosis codes preferred.

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

Skills

Attention to detail

Analytical skills

Quality focused

Independent work

Education

BHMS/BAMS/BUMS/BPT/MPT

BSc Nursing

BDS

CPC Certification

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

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
• Proven excellent analytical & comprehension skills

Preferred Qualifications

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

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.