Clinical Investigator
1 week ago
The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.
Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities.Come make an impact on the communities we serve as you help us advance health equity on a global scale.
Join us to startCaring. Connecting. Growing together.
Positions in this function are responsible for investigating, recovering and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities.
Primary 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
- 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 reassignment 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
Required Qualifications:
- Medical degree
- BHMS/BAMS/BUMS/BPT/MPT
- B.Sc Nursing and BDS with 1+ years of corporate experience
- Experience Range 6 months 3+ years (Fresher's in BPT / MPT / BHMS/ BAMS/ BUMS can also apply)
- Extensive work experience within own function
- Proven attention to detail & quality focused
- Proven good analytical & comprehension skills
Preferred Qualifications:
- Claims processing experience
- Health Insurance knowledge, managed care experience
- Knowledge of US Healthcare and coding
- Medical record familiarity
- At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes an enterprise priority reflected in our mission._
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