Remote Clinical Investigator: Claims Coding & Audit

UnitedHealth Group; Plymouth (MN); Remote; USD 68,770,000 - 123,213,000; Full time

Job summary

UnitedHealth Group is hiring a M&R Clinical Investigator to verify the accuracy of provider claims by comparing to medical records. The role supports decision making on complex payments under compliance rules, with remote work available across the U.S.

You'll review medical documentation, perform data interpretation, and communicate findings in writing to providers. A strong coding background and analytical mindset are essential for success in a production-driven setting.

Qualifications

• Proven ability to communicate clearly with diverse stakeholders.
• Analytical mindset with comfort interpreting data and medical records.
• Experience navigating multiple systems in a fast-paced environment.
• Preference for teamwork in a metric-driven setting.

Responsibilities

• Performs quality audits of clinical review cases for CPT/HCPCS/modifiers.
• Determines accuracy of medical coding/billing and payment recommendations.
• Utilizes state and federal guidelines to inform pre-payment reviews.
• Applies Evaluation and Management coding principles to determine level of service.
• Maintains daily case review assignments with quality and productivity standards.
• Collaborates with partners; can work independently when needed.

Skills

Strong communication skills

Analytical mindset

Ability to navigate multiple systems

Team collaboration

Education

Bachelor degree or higher

Tools

Microsoft Office

Adobe applications

Job description

UnitedHealth Group is hiring a M&R Clinical Investigator to verify the accuracy of provider claims by comparing to medical records. The role supports decision making on complex payments under compliance rules, with remote work available across the U.S.

You'll review medical documentation, perform data interpretation, and communicate findings in writing to providers. A strong coding background and analytical mindset are essential for success in a production-driven setting.