Clinical Investigator - Noida, India - UnitedHealth Group

UnitedHealth Group

Verified Company

Noida, India

2 weeks ago

Posted by:

Deepika Kaur

beBee Recuiter

Description

Careers at Optum have no shortage of innovation

At Optum, part of the UnitedHealth Group family of businesses, you will be part of a team that's evolving health care so everyone can have the opportunity to live their healthiest life.

The work you will do with our world-class technology team has the potential to change the lives of people around the world.

Here, at Optum, you will work with some of the brightest minds in the industry. Our teams are using data analytics, leading-edge development tools and high-end cybersecurity to help millions of people receive care. Come make a meaningful difference as we empower you to do your life's best work.
SM
Clinical Investigator

This process works on identifying discrepancies between medical records and billed services for complex and high value claims by identifying Upcoding, Unbundling, Duplication, and Misrepresentation of services.
They approve/deny claims & Identify provider aberrant behavior patterns.
The associates prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/ diagnosis codes, CMC guideline along with referring to client specific guidelines and member policies

Key Responsibilities:

Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/diagnosis codes, CMC guideline along with referring to client specific guidelines and member policies
Adherence to state and federal compliance policies and contract compliance
Assist the prospective team with special projects and reporting

Qualifications:

Medical degree
BHMS/BAMS/BUMS/BPT/MPT/ B.Sc Nursing

Skills:

Health Insurance knowledge, managed care experience preferred
Claims processing experience is helpful.
Medical record familiarity is preferred
Knowledge of US Healthcare and coding desirable
Attention to detail & Quality focused.
Good Analytical & comprehension skills

Behavioral Skills:

Customer Centricity
Strives to exceed the customer expectations through error free and timely deliverables

Communication

Communicates clearly and concisely on a routine basis (verbally and in writing)

Collaboration & Teamwork

Works collaboratively with other members of the team by sharing ideas and information

Excellence in Execution

Works hard to meets the goals/ targets given to him/her, and is motivated by opportunities for reward and recognition

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do
your life's best work. SM
**Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.