Clinical Investigator – CPC Certified
Location: Noida, Uttar Pradesh, India
Category: Claims / Clinical Review
Company: Optum
Job Type: Full-Time
Requisition Number: 2330678
Position Overview
Optum, a global leader in technology-enabled healthcare services, is seeking a CPC-Certified Clinical Investigator to support claim investigation, fraud prevention, medical review, and compliance functions. This role is ideal for clinical and coding professionals ready to contribute to healthcare quality, operational accuracy, and regulatory adherence across diverse health plan and provider networks.
The position plays a critical role in reviewing medical records, validating clinical coding, identifying claim discrepancies, and ensuring alignment with federal, state, and payer-specific policies. You will collaborate with internal teams, healthcare providers, and client stakeholders to support efficient claim resolution and health system optimization.
Key Responsibilities
Clinical and Claims Review
Prevent the payment of potentially fraudulent, abusive, or inaccurately coded claims using clinical expertise, CPT/ICD coding knowledge, and relevant guidelines.
Review pre-payment claims and supporting medical documentation to ensure appropriate reimbursement.
Assess applicable CPT/ICD guidelines, reimbursement policies, and client contracts to determine review outcomes.
Stakeholder and Client Interaction
Participate in regulatory or client-driven meetings to support audit and compliance functions.
Engage with providers, advocates, legal teams, and internal partners to assist in claim resolution and minimize provider friction.
Operations and Compliance
Monitor claim inventory to meet performance guarantees and accuracy benchmarks.
Maintain strict adherence to federal and state compliance requirements, internal policies, and contractual obligations.
Support special projects, data analysis, and reporting activities for prospective review teams and client needs.
Leadership and Independent Work
Work independently with minimal procedural guidance.
Serve as a resource for team members and may coordinate tasks across teams.
Ensure compliance with all organizational policies, employment terms, and operational directives.
Experience Required
Mandatory Qualifications
Medical degree: BHMS, BAMS, BUMS, BPT, MPT, or
B.Pharm / M.Pharm, or
B.Sc. Nursing / BDS with a minimum 1 year of corporate experience.
Certified Professional Coder (CPC) – AAPC.
CPT and ICD coding experience, or the ability to successfully complete CPC certification.
Minimum 6 months of experience as a certified coder.
Extensive experience within claims, clinical documentation review, or similar functions.
Strong attention to detail and quality-focused approach.
Proven analytical and comprehension skills.
Preferred Qualifications
Experience in claims processing or claim investigation.
Understanding of U.S. healthcare systems, managed care, and reimbursement models.
Practical experience with medical records, documentation standards, and coding workflows.
About Optum
Optum is dedicated to transforming the global healthcare landscape by combining clinical insight, advanced analytics, and cutting-edge technology. Our mission is to improve health outcomes, expand access to quality care, and support efficient health system operations.
We value diversity, equity, and inclusion and are committed to ensuring every individual has the opportunity to achieve their best health. Our teams work collaboratively to reduce disparities, enhance environmental sustainability, and advance equitable care delivery.
Role Details
Business Segment: Optum
Employee Status: Regular
Work Schedule: Full-Time, Day Shift
Travel Requirement: None
Overtime Status: Exempt
Telecommute: No
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