Clinical Investigator

7 months ago


Hyderabad Telangana, India Optum Full time

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. 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 start **Caring. Connecting. Growing together.**

The process involves 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 abusive 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 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
- 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 re-assignment 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
- Basic computer skills
- Attention to detail and quality focused
- Good analytical and comprehension skills

**Preferred Qualifications**:

- Health Insurance knowledge, managed care experience
- Claims processing 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 everyone-of every race, gender, sexuality, age, location and income-deserves 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._


  • Clinical Investigator

    4 weeks ago


    Hyderabad, Telangana, India UnitedHealth Group Full time

    At UnitedHealth Group, we're committed to helping people live healthier lives and making the health system work better for everyone. As a Clinical Investigator, you'll play a critical role in ensuring the integrity of our health insurance programs and protecting our members from potential fraud and abuse.Key Responsibilities:Investigate and resolve...

  • Clinical Investigator

    1 month ago


    Hyderabad, Telangana, India Optum Full time

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. 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,...

  • Clinical Investigator

    1 month ago


    Hyderabad, India UnitedHealth Group Full time

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. 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,...


  • Hyderabad District, Telangana, India Novartis Full time

    7000 patients, 1200 clinical sites, 40 countries, 100+ clinical studies led by Novartis Clinical Sciences & Innovation (CS&I) last year. Who are we? We are Clinical Sciences and Innovation at Novartis. A dynamic group of Clinical Scientists who plan and execute early phase trials worldwide in general medicine. From First-in-Human to Proof-of-Concept and...


  • Banjara Hills, Hyderabad, Telangana, India Dr. Krishna's Cancer Healer Center Full time

    We are looking a dedicated and capable **Assistant clinic Incharge** has responsibility for the supervision and daily operations of the Corporate Sponsored Practices. This includes Provides ongoing Quality Improvement monitors and ensures safe patient care to the clinic patients of all ages that present to the clinic, and ensures office staff is competent to...

  • Medical Writer

    1 month ago


    Madhapur, Hyderabad, Telangana, India MakroCare Clinical Research Ltd Full time

    **MakroCare** is an Expert Strategic Development and Commercialization Global Partner for Pharmaceutical,Biotechnology and Medical Device industries. Our Experience, Programs and Processes bring a NewDimension to Development Strategy, Regulatory/Risk Planning & Management, Clinical Research,Medical/Scientific Support and Emerging Region Expansion **Job...


  • Hyderabad, Telangana, India Novartis Full time

    **Summary**: - Contributes, with appropriate oversight, to all relevant aspects of global clinical trial(s) activities to deliver study outcomes within schedule, budget, quality/compliance and performance standards. May lead specific aspects of global clinical trial(s). Core member of the Clinical Trial Team. -Applicable to Clinical Scientific Expert IThe...


  • Hyderabad, Telangana, India Novartis Full time

    **Summary**: “150! Clinical scientific experts, globally, are part of Global Drug Development (GDD) team, working to ensure clinical trial data and regulatory reports are of highest quality throughout the life cycle of each program, across all disease areas. Be part of a dedicated, passionate team that is diligently providing clinical and scientific inputs...


  • Hyderabad, India Dr Reddy's Laboratories Limited Full time

    Job DescriptionJob Summary The Clinical Trial Associate (CTA) supports clinical studies and the Clinical Operations Department, in managing various administrative tasks such as generation of agenda and minutes, maintaining study tracking, filing and quality reviews as well as participating to process improvement initiatives across the departments. Roles &...


  • Hyderabad, India NITZ Consulting Private limited Full time

    **NITZ Consulting private Limited Inc. (“NItz”) **is committed to providing quality service in the field of pharmacovigilance to clients. Our clients range from mid-size to small pharmaceutical companies located worldwide who are engaged in developing a proprietary pipeline of novel therapies for the treatment of solid tumors and hematological...


  • Hyderabad, India Dr.Reddy's Full time

    ) Act as DRL’s direct contact with assigned sites, assess and ensure overall integrity of study 2) Implementation and adherence to study protocol at clinical investigational sites, and resolve site issues. Escalate issues that were unresolved to COL/PL. 3) Build and maintain relationships with investigators and site staff. 4) Facilitate and support site...


  • Hyderabad, Telangana, India Dr Reddy's Laboratories Limited Full time

    Job DescriptionAs a Clinical Trials Lead at Dr. Reddy's Laboratories Limited, you will be responsible for the preparation and review of critical documents related to clinical trials. Your expertise in clinical pharmacology and regulatory affairs will be crucial in ensuring compliance with regulatory requirements and guidelines.Key ResponsibilitiesPreparation...


  • Hyderabad, Telangana, India Dr Reddy's Laboratories Limited Full time

    Job Title: Clinical Quality Assurance SpecialistDr. Reddy's Laboratories Limited is seeking a highly skilled Clinical Quality Assurance Specialist to join our team. The successful candidate will be responsible for ensuring the quality and integrity of our clinical trials, as well as developing and implementing quality management systems.Key...


  • Hyderabad, India Makrocare Full time

    Company Description **MakroCare |** **_A MakroGroup Company_**MakroCare is an Expert Strategic Development and Commercialization Global Partner for the Pharmaceutical, Biotechnology and Medical Device industries. Our Experience, Programs and Processes bring a New Dimension to Development Strategy, Regulatory/Risk Planning & Management, Clinical Research,...


  • Hyderabad, Telangana, India Dr Reddy's Laboratories Limited Full time

    Job SummaryWe are seeking a highly skilled professional to lead the establishment and supervision of quality management systems in clinical development. This role involves strategic planning and execution of audits, ensuring adherence to GxP standards, and driving quality assurance initiatives across diverse systems.Key ResponsibilitiesSupport the...

  • Clinical Investigator

    7 months ago


    Hyderabad, India UnitedHealth Group Full time

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. 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,...


  • Hyderabad, Telangana, India Bristol-Myers Squibb Full time

    **Working with Us** Challenging. Meaningful. Life-changing. Those aren’t words that are usually associated with a job. But working at Bristol Myers Squibb is anything but usual. Here, uniquely interesting work happens every day, in every department. From optimizing a production line to the latest breakthroughs in cell therapy, this is work that transforms...


  • Hyderabad, Telangana, India Bristol-Myers Squibb Full time

    **Working with Us** Challenging. Meaningful. Life-changing. Those aren't words that are usually associated with a job. But working at Bristol Myers Squibb is anything but usual. Here, uniquely interesting work happens every day, in every department. From optimizing a production line to the latest breakthroughs in cell therapy, this is work that transforms...


  • Hyderabad, Telangana, India Bristol Myers Squibb Full time

    Job DescriptionThis role is responsible for managing and executing centralized activities in support of global clinical trials, with a focus on clinical documentation. The successful candidate will interact with CROs, vendors, country trial managers, and other stakeholders to ensure compliance with regulatory standards and Bristol Myers Squibb policies.Key...


  • Hyderabad, India Ferring Pharmaceuticals Full time

    Job Description:Role: Associate Director – Bio-clinical studiesReporting to: Senior Director - Pharmaceutical DevelopmentLocation: HyderabadExperience: At least 15 years of industrial experience in the following:Drug product development in early to late phase clinical development.Hands on experience in BA-BE studies in healthy volunteers.Hands on...