Clinical Investigator – Noida, Uttar Pradesh, India
Requisition Number: 2299562
Category: Claims
About the Role
Optum, a leading global healthcare organization, is seeking a skilled Clinical Investigator to support claims investigation, recovery and resolution processes. This position plays a vital role in improving health outcomes by ensuring accurate claims handling and adherence to clinical and compliance guidelines. The role requires strong medical expertise, analytical skills and the ability to work independently in a fast-paced, compliance-driven environment.
This opportunity offers exposure to global healthcare operations, diversity-driven culture, advanced technology, and career development paths.
Key Responsibilities
Investigate, assess and prevent potentially fraudulent, abusive, or non-compliant claims using medical expertise, CPT/diagnosis codes and applicable guidelines including CMC and client-specific policies.
Review, analyze and pursue recoveries and payables for subrogation-related claims.
Ensure strict adherence to state and federal regulatory compliance, reimbursement protocols and contractual policies.
Collaborate with internal teams on special projects, reporting and process improvement.
Review medical histories and assess contestable claims when required.
Independently manage workload with minimal procedural guidance and act as a resource to peers when needed.
Support coordination activities across teams as directed.
Comply with organizational policies, including reassignment, workplace flexibility and operational directives as business needs evolve.
Required Qualifications
Educational Background:
Medical degree: BHMS / BAMS / BUMS / BPT / MPT
B.Sc Nursing or BDS candidates must have at least 1 year of corporate experience
Experience Range:
6 months to 3 years of relevant experience
Freshers from BPT, MPT, BHMS, BAMS or BUMS are also eligible
Core Skills:
Strong attention to detail and quality-focused mindset
Excellent analytical and comprehension abilities
Solid experience working within a functional domain (for experienced candidates)
Preferred Qualifications
Prior experience in claims processing
Knowledge of health insurance, managed care, and US healthcare operations
Familiarity with medical records and healthcare coding standards
Why Join Optum?
At Optum, you will work with a global team committed to advancing health equity and enhancing patient outcomes. You will be part of an inclusive culture supported by technology, innovation and continuous learning opportunities.
Gujarat :
Ahmedabad | Ankleshwar | Baroda | Bharuch | Gandhinagar | Gujarat | Halol | Jhagadia | Mehsana | surat | Tarasadi | Vadodara | Vapi |Maharashtra :
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Siliguri |Illinois :
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Appleton | Kenosha | Pleasant Prairie | Portage | Waukesha |United states :
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Frank Scottile Blvd |Missouri :
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Canada |Quebec :
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Brussels |Antwerp :
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Peru | Argentina |Brazil :
Brazil | Sao paulo |Attica :
Koropi | Athens |Greece :
Greece |North Island :
Auckland |New Zealand :
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Austria |Vienna :
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Madrid |Cebu Province :
Cebu City |Philippines :
Manila |Croatia :
Croatia |Zagreb :
Zagreb |Estonia :
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Tallinn |Hà Nội :
Hanoi | Hà Nội |Ho Chi Minh :
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Kuala Lumpur |Kyiv Oblast :
Kyiv |Lima Region :
Lima |France :
Paris | Lyon |South Africa :
Midrand | South Africa |Nišava District :
Niš |Bohemia :
Prague |Chile :
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