CLINICAL INVESTIGATOR Fresher's job

Job Description

Purpose of Job

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 policies

Job 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

Desired Candidate Profile

-Medical degree - BHMS/BAMS/BUMS/BPT/MPT/BDS/Nursing

-Good Analytical & comprehension skills

Perks and Benefits

Day Shift

Free Transport facility (Pick and Drop)

Optum, the fast growing part of UnitedHealth Group, is a leading information and technology-enabled health services business. Our teams are dedicated to modernizing the health care system and improving the lives of people and communities. Watch this short video to learn more.