Clinical Investigator

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 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 May include initiating telephone calls to members providers and other insurance companies to gather coordination of benefits data Investigate and pursue recoveries and payables on subrogation claims and file management Process recovery on claims Ensure adherence to state and federal compliance policies reimbursement policies and contract compliance May conduct contestable investigations to review medical history May monitor large claims including transplant cases 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 Eligibility To apply to an internal job employees must meet the following criteria Minimum 12 months in the current role Not on Active CAP at the time of applying for the IJP Employees at SG 22 and SG 23 are eligible Employees must notify their Current Manager before applying for the IJP Last Common Review rating should be Meeting Expectations or Exceeding Expectations Required Qualifications Medical degree - BHMS BAMS BUMS BPT MPT B Sc Nursing and BDS with 1 year 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 xe2x80x94 an enterprise priority reflected in our mission