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Clinical Investigator – Cpc Certified

0.6 years
Not Disclosed
10 Dec. 2, 2025
Job Description
Job Type: Full Time Education: B.Sc/M.Sc/M.Pharma/B.Pharma/Life Sciences Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

Clinical Investigator – CPC Certified

Location: Noida, Uttar Pradesh, India
Company: Optum (UnitedHealth Group)
Job Category: Claims
Job Type: Full-Time
Requisition Number: 2330678

Position Overview

Optum is hiring a Clinical Investigator – CPC Certified to support claim investigation, fraud waste and abuse (FWA) detection, coding-based claim review, and medical policy compliance. The role involves analyzing pre-payment claims using CPT/ICD coding expertise, reviewing medical records, and ensuring accurate claim adjudication in alignment with clinical and reimbursement guidelines.

This position is ideal for healthcare professionals with coding certification (CPC) and experience in claims, clinical review, or US healthcare operations.


Key Responsibilities

  • Prevent payment of inaccurate, abusive, or potentially fraudulent claims using clinical knowledge, CPT/ICD coding, CMC guidelines, and client-specific policies.

  • Review pre-pay claims with medical records to assess payment correctness and clinical justification.

  • Interpret CPT guidelines, reimbursement rules, contracts, and medical policies during claim evaluation.

  • Participate in client regulatory meetings and support discussions related to clinical reviews.

  • Interact with providers, advocates, and legal teams to support resolution and minimize provider friction.

  • Work on special projects, data analysis, and cross-functional collaboration as required.

  • Monitor claim inventory to ensure performance guarantee adherence.

  • Ensure compliance with federal and state guidelines, company policies, and audit requirements.

  • Perform work independently and act as a resource for peers when needed.

  • May coordinate activities of team members based on project requirements.


Required Qualifications

Educational Background (Any one):

  • BHMS / BAMS / BUMS

  • BPT / MPT

  • B.Pharm / M.Pharm

  • B.Sc Nursing

  • BDS (with minimum 1 year corporate experience)

Certifications & Skills:

  • Certified Professional Coder (CPC) – AAPC

  • CPT & ICD coding experience

  • OR must pass CPC certification (if not yet certified)

  • Minimum 6 months experience as a certified coder

  • Strong analytical, comprehension, and documentation skills

  • High attention to detail and quality-focused mindset

  • Extensive work experience within the healthcare/claims function preferred


Preferred Qualifications

  • Claims processing experience

  • Familiarity with US healthcare and managed care systems

  • Experience with medical records and documentation review

  • Knowledge of health insurance operations and coding workflows


About Optum / UnitedHealth Group

Optum, part of UnitedHealth Group, is a global healthcare technology and services leader. The organization focuses on improving healthcare outcomes, promoting equity, and advancing the healthcare system through data-driven insights. Employees benefit from an inclusive culture, development opportunities, and impactful work that supports healthier communities worldwide.


Job Details

  • Business Segment: Optum

  • Employee Status: Regular

  • Schedule: Full-Time

  • Shift: Day Shift

  • Travel: No

  • Overtime Status: Exempt

  • Telecommute: No