Senior Clinical Investigator – CPC Certified
Location: Hyderabad, Telangana, India
Employer: Optum
Job Category: Medical & Clinical Operations
Requisition Number: 2327427
Employment Type: Full-Time | Permanent
Experience Level: 6 months to 3+ years
About the Organization
Optum is a global healthcare leader focused on elevating clinical outcomes through technology-driven solutions. With a mission to enhance health optimization across diverse populations, Optum provides an inclusive, collaborative, and growth-oriented work environment. Professionals joining our team contribute directly to improving healthcare quality, efficiency, and accessibility worldwide.
Position Overview
The Senior Clinical Investigator – CPC Certified plays a key role in evaluating clinical claims, ensuring compliance, and safeguarding healthcare resources. This function involves reviewing, investigating, and resolving claim discrepancies for health plans, government entities, and commercial clients. The role requires strong clinical judgment, coding expertise, and the ability to work independently while supporting cross-functional teams.
Key Responsibilities
Prevent improper or fraudulent claim payments using clinical knowledge, CPT/ICD coding skills, CMC guidelines, and client-specific policies.
Review pre-payment claims and associated medical records to ensure accuracy and compliance.
Interpret CPT guidelines, reimbursement policies, and contractual obligations relevant to claim evaluations.
Participate in regulatory and provider meetings to support clinical and audit discussions.
Support internal and external stakeholders by analyzing data, conducting investigations, and resolving clinical review cases.
Maintain continuous oversight of claim inventory to meet performance and turnaround targets.
Ensure adherence to federal and state compliance standards.
Assist with special projects, reporting activities, and operational improvements.
Operate independently and serve as a resource or coordinator for team activities when required.
Comply with all company policies, updated directives, work arrangement guidelines, and operational shifts.
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) mandatory
CPT and ICD coding experience, or ability to clear AAPC CPC certification
Minimum 6 months of coding experience (certified)
Total Experience Range: 6 months to 3+ years
Strong analytical, comprehension, and documentation skills
High attention to detail and strong quality focus
Preferred Qualifications
Claims processing experience
Knowledge of US healthcare systems, managed care, and reimbursement models
Familiarity with medical records and documentation standards
Prior experience in clinical operations or healthcare investigation roles
Why Join Optum
Optum is committed to fostering a workplace rooted in diversity, equity, and inclusion. The company prioritizes the removal of health disparities and supports sustainable, responsible business practices.
Employees gain access to competitive benefits, skill development programs, and long-term career progression opportunities within a global organization that values innovation and integrity.
Job Details
Schedule: Day Shift
Travel: No
Overtime Status: Exempt
Telecommute: No
Location: Hyderabad, India
Gujarat :
Ahmedabad | Ankleshwar | Baroda | Bharuch | Gandhinagar | Gujarat | Halol | Jhagadia | Mehsana | Tarasadi | Vadodara | Vapi |Maharashtra :
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Bilaspur | Eot Municipality | Raipur |Uttarakhand :
Dehradun | Halifax | Nainital | Rishikesh | Roorkee |Delhi :
Delhi | India | New Delhi | PAN-India |Assam :
Dibrugarh | Diburghar | Guwahati |West Bengal :
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Gajraula | Gautam buddha Nagar | Ghaziabad | Gorakhpur | Greater Noida | Jhansi | Lucknow | Mathura | Noida | Park City | Prayagraj | Satyamev | Varanasi |Goa :
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Hajipur | Patna |Kerala :
Kannur | Kochi | Malappuram | Thiruvananthapuram | Trivandrum |Pondicherry (Puducherry) :
Pondicherry (Puducherry) |Jharkhand :
Ranchi |Sikkim :
Rangpo |India :
Siliguri |Illinois :
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Andover | Billerica | Boston | Cambridge | Devens | Lexington | Massachusetts | Medford and Somerville | Rockland |Wisconsin :
Appleton | Kenosha | Pleasant Prairie | Portage | Waukesha |United states :
Arizona | Buffalo Grove | Clayton | Downers Grove | fairmont | Georgia | Keene | Michigan | Mt. Pleasant | New Jersy | OH | Piedmont | Salisbury | United States | Whitesboro | Winston-Salem |Georgia :
Atlanta | Augusta | Rome |Maine :
Bangor | Brewer |New Jersey :
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Chandler | Kingman | Lake Havasu City | Mesa | Peridot | Phoenix | Surprise | Tempe | Tucson | Yuma |South Carolina :
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Concord | Lumberton | North Carolina |Michigan :
Detroit | Houghton Lake | Macomb | Southfield |North Dakota :
Dickinson |Minnesota :
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Frank Scottile Blvd |Missouri :
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Hawai | kentucky | Sylmar | Woonsocket |Nebraska :
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Hilo | Honolulu |Tennessee :
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Lisbon | Oeiras | Portugal |WI :
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New Hampshire |Oklahoma :
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Bavaria |Bavaria :
Bayreuth | Erlangen | Munich | Regensburg | Wurzburg |Brandenburg :
Berlin |Baden-Wurttemberg :
Biberach an der Riß | Freiburg | Grenzach | Heidelberg | Karlsruhe | Konstanz | Stuttgart | Tubingen | Ulm |Hesse :
Darmstadt | Marburg |Hessen :
Frankfurt | Harveysburg |Germany :
Germany | GErmany |Lower Saxony :
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Rostock |Saarland :
Saarbrucken |Switzerland :
Basel | Zurich |Serbia :
Belgrade | Serbia |Hungary :
Budapest |BULGARIA :
Bulgaria | Vedant |Denmark :
Copenhagen | Denmark |Europe :
Europe | France | Latvia | Lendava | Leuven | Poland | Slovenia | Spain |Finland :
Finland |Istanbul :
Istanbul | Turkey |Norway :
Norway | NOrway |Romania :
Romania |Belgium :
Wavre |Tipperary :
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Dunboyne |Dún Laoghaire :
Dún Laoghaire |Galway :
Galway |County Dublin :
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China | Quarry Bay |Liaoning :
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Hangzhou |Tokiyo :
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Wuhan |Capital of Netherland :
Amsterdam |North Brabant :
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Netherlands |Remote Australia :
Arkansas | Remote Australia |New South Wales :
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Nedlands |Queensland :
Queensland |Melbourne :
South Yarra |United Kingdom :
England | Harlow | Leeds | London | Maidenhead | Salt Lake City | Stevenage | Stirling | United Kingdom |North Yorkshire :
Harrogate |South Yorkshire :
Sheffield |Oxfordshire :
Witney |Ontario :
Uxbridge | Richmond Hill | Australia | Mississauga | Renfrew | North York |Canada :
Canada |Quebec :
Montreal |Brussels :
Brussels |Antwerp :
Heist op den Berg |Flemish Brabant :
Zaventem |South America :
Argentina | Peru |Brazil :
Brazil | Sao paulo |Attica :
Koropi | Athens |Greece :
Greece |North Island :
Auckland |New Zealand :
New Zealand |Austria :
Austria |Vienna :
Vienna |Catalonia :
Barcelona |Madrid :
Madrid |Cebu Province :
Cebu City |Philippines :
Manila |Croatia :
Croatia |Zagreb :
Zagreb |Estonia :
Tartu | Estonia |Harju County (Maakond) :
Tallinn |Hà Nội :
Hà Nội | Hanoi |Ho Chi Minh :
Ho Chi Minh City |Italy :
Italy |Lombardy :
Rho |Jakarta :
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Saitama | Japan |Tokyo :
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Brentwood |Bucharest :
Bucharest |Buenos Aires :
Buenos Aires |Republic of Egypt :
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New Mexico | Ciudad de México |Dubai :
Dubai |Makkah :
King Abdullah Economic City | Rabigh | Khulais | Najran | Riyadh | Jeddah |Kuala Lumpur :
Kuala Lumpur |Kyiv Oblast :
Kyiv |Lima Region :
Lima |France :
Paris | Lyon |South Africa :
Midrand | South Africa |Nišava District :
Niš |Bohemia :
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