Clinical Investigator

1 week ago

Noida, Uttar Pradesh, 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 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 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 abusive claims utilizing medical expertise knowledge of CPT diagnosis codes CMC guideline along with referring to client specific guidelines and member policiesPrimary 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 - Graduate or Postgraduate - BHMS BAMS BUMS BPT BSC-Nursing only Experience Range - 0 to 5 years Fresher s can apply Attention to detail Quality focused Good comprehension skills Please note that below mentioned graduates are not eligible to apply BA BBA BBE BCOM B-tech M-Tech B-Pharma M-Pharma D-Pharma BDS MDS- with no previous corporate experience Perks and Benefits Work from Office role Monday to Friday working Saturdays Sundays fixed off Free cab facility Competent Salary Quarterly Incentives Provident Fund Insurance Cover of self and family 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

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