Clinical Investigator
About the Role
Company Description
UnitedHealth Group is a healthcare company that works to make health better and healthcare work better. Through companies like Optum and UnitedHealthcare it brings together healthcare services, technology, pharmacy benefits, data and analysis to help people and organizations. It focuses on ideas being fair good quality and making sure everyone can get care. It also gives people chances to learn and grow in healthcare and technology jobs.
Job Summary
The Clinical Investigator checks claims to find possible fraud, wrong billing and wrong payments. The job needs knowledge, understanding of CPT and diagnosis codes CMS guidance, client needs and member rules to make sure claims are handled right. The person also helps with projects, reports, teamwork, following rules and changing processes while keeping high levels of accuracy thinking on their own and good quality.
Key Responsibilities
Check claims for possible fraudulent or abusive billing practices.
Use knowledge and understand CPT and diagnosis codes.
Use CMS guidelines, client requirements and member policies when checking claims.
Help make sure claims are paid correctly and follow rules.
Follow state, federal and contractual compliance requirements.
Help with projects, investigations, reports and daily work.
Work with others. Share important changes in the process.
Keep work high quality and follow company rules.
Educational Qualification
Degree in BHMS, BAMS, BUMS, BPT, MPT, Bachelor of Nursing, or BDS.
CPC certification.
At 6 months of experience; however freshers from BPT/MPT/BHMS/BAMS/ BUMS can apply.
Good ability to think and understand.
Can work on their own.
Preferred Qualification
Experience in handling claims.
Know about health insurance or managed care.
Know about U.S. Healthcare and medical coding.
Know how to read records.
Skills Required
Medical terminology, medical records interpretation.
CPT codes, diagnosis codes, medical coding.
U.S. Healthcare, health insurance managed care.
Claims review, fraud/waste/abuse identification.
Data interpretation, analytical thinking, problem-solving ability.
Attention to detail, accuracy quality orientation.
CMS guidelines, regulatory and contractual compliance.
Communication, teamwork, independent working.
Documentation, reporting process updates.
Salary Structure
The average salary for a Clinical Investigator at Optum in India ranges from ₹4.3 Lakhs to ₹5.2 Lakhs per year.
Career Development
This job gives experience in U.S. Healthcare, medical coding, claims investigation, healthcare compliance and fraud/waste/abuse analysis helping this job holder to move into roles in investigation, claims, coding or healthcare operations. UnitedHealth Group also talks about training, guidance, learning and chances to grow in the future.
How to Apply
Go to our careers portal . Look for Clinical Investigator - Optum
Open the job, Check the requirements carefully.
Click Apply. Sign in or make a candidate account to send your application and resume.
Fill in all the parts and send your application through the official website.
Market Insights & Trends
Salary Insights
The amount of money that gets paid can be different depending on how they have been working, where they live and what kind of job they are doing. Some places pay more than others. Most good jobs include extra money for doing a good job, health insurance and flexible hours. Companies pay high salary to make sure they can get the people they want.
Hiring Trends
The number of jobs for this profile is going up every year. Hospitals and other healthcare companies are looking for people who're good, at their job and can also figure out new problems. They want who can do the work and also think on their feet to deal with the challenges of working in healthcare today.