Senior Clinical Investigator – CPC Certified
Location: Hyderabad, Telangana, India
Employer: Optum
Job Category: Medical & Clinical Operations
Requisition Number: 2327427
Employment Type: Full-Time | Day Shift | Regular
About Optum
Optum is a global healthcare organization committed to transforming health outcomes through technology, data, and clinical expertise. As part of a diverse, inclusive, and innovation-driven environment, you will contribute directly to improving patient care, optimizing health delivery, and supporting large-scale healthcare operations worldwide.
Role Overview
The Senior Clinical Investigator is responsible for evaluating, investigating, and resolving clinical claims for health plans, commercial entities, and government programs. This role requires strong clinical judgment, detailed knowledge of CPT and ICD coding, and the ability to analyze medical records for compliance and accuracy. As a key contributor, you will ensure adherence to federal and state regulations while supporting operational accountability and claim accuracy.
Key Responsibilities
Prevent improper or fraudulent claim payments through clinical review, medical expertise, CPT/ICD code knowledge, and reference to client-specific guidelines.
Review pre-payment claims and supporting medical records to determine accuracy and compliance.
Interpret and apply CPT guidelines, reimbursement policies, and contractual requirements during claim evaluation.
Participate in regulatory meetings and support discussions with clients, providers, and internal teams.
Collaborate with advocates and legal teams to assist with provider-related matters.
Analyze data for special assignments and engage with stakeholders for case resolution.
Continuously monitor claim inventory to meet service-level and performance targets.
Ensure adherence to federal and state compliance frameworks and corporate policies.
Support prospective teams with project work, reporting, and operational improvements.
Work independently, often without predefined procedures, and serve as a resource for team coordination when needed.
Comply with organizational directives, including reassignment, shift changes, flexible work policies, and evolving business requirements.
Required Qualifications
Medical Degree: BHMS, BAMS, BUMS, BPT, MPT
Pharmacy Degree: B.Pharm or M.Pharm
B.Sc. Nursing or BDS with a minimum of 1 year of corporate experience
Certified Professional Coder (CPC)
CPT and ICD coding experience, or the ability to pass AAPC CPC certification
Minimum 6 months of certified coding experience
Total Experience Required: 6 months to 3+ years
Strong analytical skills, comprehension ability, and attention to detail
Demonstrated commitment to quality and accuracy within clinical or operational functions
Preferred Qualifications
Experience in claims processing
Knowledge of US healthcare systems, managed care, and payer operations
Familiarity with medical documentation and clinical record interpretation
Prior experience in coding-based audits or healthcare investigation roles
Work Environment and Commitment
UnitedHealth Group is dedicated to improving health equity and reducing disparities across global communities. The organization fosters an inclusive culture built on respect, accessibility, and equitable opportunities for all employees.
Employees benefit from comprehensive development programs, competitive benefits, and a stable global platform for career growth.
Additional Job Details
Business Segment: Optum
Travel: No
Overtime Status: Exempt
Schedule: Full-Time, Day Shift
Telecommute: No
Location: Hyderabad, India
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Auckland |New Zealand :
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Madrid |Cebu Province :
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Croatia |Zagreb :
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