Clinical Investigator - Gurgaon Jobs in Delhi - Optum Global Solutions India Private Limited
Clinical Investigator - Gurgaon
Job Description
This process works on identifying discrepancies between medical records and billed services for complex and high value claims by identifying Up-coding, 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 claims utilizing medical expertise, knowledge of CPT/diagnosis codes, CMC guideline along with referring to client specific guidelines and member policies.Primary Responsibilities:Prevent the payment of potentially fraudulent and/or claims utilizing medical expertise, knowledge of CPT/diagnosis codes, CMC guideline along with referring to client specific guidelines and member policiesAdhere to state and federal compliance policies and contract complianceAssist the prospective team with special projects and reporting
Required Candidate profile
Required Qualifications:Medical degree - BHMS/ BAMS/ BUMS/ BPT/ MPT/BDS/Graduate in Nursing
0-4 years of over-all experience (Freshers can apply)Attention to detail and Quality focused
Good Analytical and comprehension skills
Preferred Qualifications:Claims Processing experience
Health Insurance knowledge, Managed Care experience
Knowledge of US Healthcare and Coding
Medical Record familiarity
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
Job Location : Gurgaon
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