Clinical Investigator Job at Optum
A rare chance has emerged for aspiring professionals in the healthcare sector as Optum offers a clinical investigator job in Chennai, India. This role is pivotal in enhancing healthcare outcomes through effective claims management and investigation.
About Optum:
Optum is a global organisation that delivers care, aided by technology, to help millions of people live healthier lives. The work conducted by the team directly improves health outcomes by connecting individuals with necessary care, pharmacy benefits, data, and resources. With a culture guided by inclusion, talented peers, comprehensive benefits, and career development opportunities, Optum fosters an environment where professionals can make a significant impact on the communities they serve. The organisation is committed to advancing health optimisation on a global scale, making it an ideal place for those seeking clinical investigator jobs.
Job Details:
- Requisition number: 2371605
- Job category: Claims
- Primary location: Chennai, India
- Date posted: 08 August 2026
- Overtime status: Exempt
- Travel: No
Job Description:
Positions in this function are responsible for investigating, recovering, and resolving all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities. This may include initiating telephone calls to members, providers, and other insurance companies to gather coordination of benefits data. The role involves investigating and pursuing recoveries and payables on subrogation claims and file management, processing recovery on claims, and ensuring adherence to state and federal compliance policies, reimbursement policies, and contract compliance. The position may also conduct contestable investigations to review medical history and monitor large claims, including transplant cases.
Key Responsibilities:
- Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/diagnosis codes, CMC guidelines, along with referring to client-specific guidelines and member policies.
- Ensure adherence to state and federal compliance policies and contract compliance.
- Assist the prospective team with special projects and reporting.
- Work is frequently completed without established procedures.
- Work independently and may act as a resource for others.
- May coordinate others’ activities.
- Comply with the terms and conditions of the employment contract, company policies and procedures, and any directives that may arise due to the changing business environment.
Required Qualifications for this Clinical Investigator Job:
- Graduation – Any Graduate, BHMS/BAMS/BUMS/BPT/MPT (preferred).
- B.Sc Nursing and BDS with 1+ years of corporate experience.
- Certified coder through AAPC.
- Certifications accepted – CPC only.
- 1+ years of experience (if not a medical graduate) in speciality coding such as E&M, surgery, anaesthesia, etc., but not only HCC.
- Extensive work experience within own function.
- Proven attention to detail & Quality focused.
- Proven excellent analytical & comprehension skills.
Skills Required for this Clinical Investigator Job:
- Claims processing experience.
- Health Insurance knowledge, managed care experience.
- Knowledge of US Healthcare and coding.
- Medical record familiarity.
