Medical Job at Optum | BHMS/BAMS/BUMS Graduates Apply
Looking for a medical job that combines clinical expertise with healthcare claims accuracy? Optum is hiring a Clinical Investigator – CPC Certified professional in Noida, offering one of the most promising Optum jobs for skilled medical coders and healthcare specialists. This role provides immense growth opportunities, advanced technology exposure, and the chance to work in one of the most in-demand jobs in Noida within the medical and claims investigation domain.
Medical Job Details:
- Job Title: Clinical Investigator – CPC Certified
- Requisition Number: 2330678
- Job Category: Claims
- Primary Location: Noida, Uttar Pradesh, IN
About the Company
Optum is a global organization committed to improving health outcomes through advanced technology, data-driven care, and high-quality healthcare services. Serving millions worldwide, Optum fosters a culture of inclusion, innovation, comprehensive employee benefits, and continuous career growth. By joining Optum, you contribute to advancing global health optimization while impacting the communities the company serves.
Qualifications:
- Medical degree – BHMS/BAMS/BUMS
- Certified Professional Coder – CPC
- CPT & ICD coding experience or must pass AAPC CPC Certification
- Experienced certified coder (6 months)
- BDS with 1 year of corporate experience
- Experience Range: Extensive work experience within own function
- Proven attention to detail & Quality focused
- Proven good Analytical & comprehension skills
Job Description:
The Clinical Investigator – CPC Certified role involves the investigation, recovery, and resolution of various healthcare claims across commercial clients, health plans, and government entities. Responsibilities include evaluating claims, coordinating benefits, reviewing medical records, analyzing data, and ensuring compliance with state and federal policies. This position requires strong knowledge of CPT/diagnosis codes, client guidelines, and reimbursement standards.
Medical Job – 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
- Reviews prepay claims with corresponding medical records to determine payment accuracy
- Reviews applicable policies, CPT guidelines and contracts as they pertain to clinical review
- Participate in regulatory meetings with client
- Participates in meetings with providers, advocates and legal to assist with provider abrasion
- Performs additional projects as needed by the business or Client; analyzes data; meets with internal and external stakeholders as necessary for resolution
- Continuous monitoring of claim inventory in order to adhere to performance guarantees
- 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
- Works independently
- 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 and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment).
- The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so.
