Clinical Investigator
Clinical Investigator
Optum
Job description
Looking to build a career in medical claims investigation? Explore this Clinical Investigator role at Optum, part of UnitedHealth Group, in Noida.
Company Description
Optum is a company that operates all around the world. It helps people get care by using technology. The goal is to help millions of people be healthier. The company brings people with care things like medicine, data and other tools that people need to feel good. They follow values like being honest, showing care and making sure everyone feels included. Optum tries to make health better for people around the world. It is part of UnitedHealth Group. The company is working to make the health system stronger.
Job Summary
This role focuses on investigating, recovering, and resolving different types of medical claims. As a Clinical Investigator, you will review claims for health plans, commercial customers, and government entities, using medical expertise and coding knowledge. Your work will include reviewing medical history, monitoring large claims, and pursuing recoveries on subrogation cases. The role also involves working independently while following state and federal compliance policies.
Key Responsibilities
Prevent payment of potentially fraudulent or abusive claims using medical and coding expertise.
Apply CPT and diagnosis code knowledge, along with CMS and client-specific guidelines.
Follow state and federal compliance policies, along with contract requirements.
Support the prospective team with special projects and reporting tasks.
Work independently, often without established step-by-step procedures.
Act as a resource for colleagues when needed.
Help coordinate activities across the wider team.
Investigate and pursue recoveries and payables on subrogation claims.
Review medical history during contestable claim investigations, when required.
Monitor large or complex claims, including transplant related cases.
Educational Qualification
Any graduate degree, or a degree in BHMS, BAMS, BUMS, BPT, or MPT, with these preferred.
B.Sc. Nursing or BDS graduates need at least 1 year of corporate experience.
A Certified Professional Coder, CPC, credential through AAPC is required.
Skills Required
More than 1 year of experience in specialty coding, such as E&M, surgery, or anesthesia, if not a medical graduate.
Strong, extensive work experience within your specific function.
Strong attention to detail and a quality focused mindset.
Good analytical and comprehension skills.
Claims processing experience is preferred.
Knowledge of health insurance and managed care is helpful.
Familiarity with US healthcare systems and medical coding is a plus.
Comfort reviewing and understanding medical records.
Salary Structure
The average salary for a Clinical Investigator at Optum Global Solutions ranges from ₹4.5 Lakhs to ₹5.2 Lakhs per year.
Career Development
This role offers hands on exposure to medical claims investigation within a large, globally connected healthcare company. Optum also supports long term growth through continuous training, mentorship, and clear paths for career advancement.
How to Apply
Visit our job portal and search for the Clinical Investigator role - Optum.
Click on the job posting to read all the details, about the job.
Fill in your details. Upload your updated resume.
Send your application.
Education
Bachelor's Degree
Key Skills
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.