Clinical Investigator Job at Optum | Apply Now
The clinical investigator job opportunity at Optum in Noida offers healthcare professionals a chance to build a rewarding career in claims investigation and fraud prevention. If you are looking for optum careers, bds jobs, or exciting clinical jobs in the health insurance and managed care sector, this role provides excellent exposure to US healthcare systems, medical coding, and compliance practices. Freshers and experienced professionals alike can apply and become part of a global healthcare organization focused on improving lives.
Job details:
- Job Position: Clinical Investigator
- Job ID: 2347868
- Location: Noida, Uttar Pradesh, India
About the Company:
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. At Optum, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Join one of the fastest-growing optum careers pathways and make an impact on the communities we serve as you help advance health optimization on a global scale.
Job Description:
This clinical investigator job role is responsible for investigating, recovering and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities. The position may include:
- Initiating telephone calls to members, providers and other insurance companies to gather coordination of benefits data
- Investigating and pursuing recoveries and payables on subrogation claims
- File management and processing recovery on claims
- Ensuring adherence to state and federal compliance policies, reimbursement policies and contract compliance
- Conducting contestable investigations to review medical history
- Monitoring large claims including transplant cases
Qualifications:
Required:
- Medical degree
- BDS with 1 year of corporate experience
- Extensive work experience within own function
- Proven attention to detail & quality focus
- Proven good analytical & comprehension skills
Preferred:
- Claims processing experience
- Health insurance knowledge and managed care experience
- Knowledge of US healthcare and coding
- Medical record familiarity
Key Responsibilities:
- Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise
- Use knowledge of CPT/diagnosis codes, CMC guideline and client specific guidelines and member policies
- Adhere to state and federal compliance policies and contract compliance
- Assist the prospective team with special projects and reporting
- Complete work frequently without established procedures
- Work independently
- Act as a resource for others
- Coordinate others’ activities when required
- Comply with employment contract terms, company policies and procedures
