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    Clinical Investigator

    Optum
    0-3 years
    Not Disclosed
    Noida
    12 June 3, 2024
    Job Description
    Job Type: Full Time Education: B.Sc./ M.Sc./ M.Pharm/ B.Pharm/ Life Sciences Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, ICD-10 CM, CPT, HCPCS Coding, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

    Job Opportunity: Claims Investigator at Optum

    Location: Global
    Company: Optum, a part of UnitedHealth Group

    About Optum:

    Optum is a global organization dedicated to delivering care aided by technology to help millions live healthier lives. Our work directly improves health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. We foster a culture guided by diversity and inclusion, with talented peers, comprehensive benefits, and career development opportunities. Join us to make an impact on the communities we serve and help us advance health equity on a global scale.

    Position Overview:

    This role involves investigating, recovering, and resolving all types of claims, including for health plans, commercial customers, and government entities. Responsibilities include initiating telephone calls to members, providers, and other insurance companies to gather coordination of benefits data, pursuing recoveries and payables on subrogation claims, and ensuring adherence to state and federal compliance policies.

    Primary Responsibilities:

    • Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise and knowledge of CPT/diagnosis codes, CMC guidelines, and client-specific guidelines.
    • Ensure adherence to state and federal compliance policies and contract compliance.
    • Assist the prospective team with special projects and reporting.
    • Work independently, frequently without established procedures.
    • May act as a resource for others and coordinate others’ activities.
    • Comply with employment contract terms, company policies, and any directives, including potential re-assignment to different work locations, teams, or shifts.

    Required Qualifications:

    • Education: Medical degree (BHMS/BPT/MPT/BDS/B.Sc Nursing)
      • BDS candidates considered with relevant experience in corporate or clinic settings.
      • B.Sc Nursing candidates considered with relevant corporate experience.
      • Freshers with BPT/MPT/BHMS degrees can also apply.
    • Experience: 6 months – 3 years (extensive work experience within own function is essential).
    • Skills:
      • Proven attention to detail and quality-focused.
      • Strong analytical and comprehension skills.

    Preferred Qualifications:

    • Experience in claims processing.
    • Knowledge of health insurance and managed care.
    • Familiarity with US healthcare and coding.
    • Experience with medical records.

    Why Join UnitedHealth Group:

    At UnitedHealth Group, our mission is to help people live healthier lives and improve the health system for everyone. We believe everyone deserves the opportunity to live their healthiest life, regardless of race, gender, sexuality, age, location, or income. We are committed to addressing health disparities and improving health outcomes, with a focus on mitigating environmental impacts and delivering equitable care.

    How to Apply:

    Interested candidates should submit their CV to [Optum's Careers Page or the specified email address]. Include a brief explanation of why you believe you are a great fit for this role in the body of the email.

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