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99 Optum Jobs

Clinical Investigator

0-3 years

Noida

1 vacancy

Clinical Investigator

Optum

posted 1mon ago

Job Role Insights

5 Days Working·Flexible timing·Night Shift

Job Description

  • 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
  • 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 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 and BDS with 1 year of corporate experience
  • Experience Range - 06 months - 3 years (Freshers 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

Employment Type: Full Time, Permanent

Functional Areas: Other

Read full job description

People are getting interviews at Optum through

(based on 229 Optum interviews)
Job Portal
Referral
Walkin
Campus Placement
Company Website
Recruitment Consultant
23%
22%
17%
14%
8%
5%
11% candidates got the interview through other sources.
High Confidence
?
High Confidence means the data is based on a large number of responses received from the candidates.

Optum Interview Questions and Tips

Prepare for Clinical Investigator jobs at Optum with interviews advice from real interviews

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What people at Optum are saying

3.8
Rating based on 66 Clinical Investigator reviews

Likes

Work life balance, hybrid policy, cab facility

Dislikes

Biasness

Read 66 reviews

Clinical Investigator salary at Optum

reported by 380 employees

Average annual salary

4.2 Lakhs
₹2 L/yr - ₹6 L/yr
12% less than the average Clinical Investigator Salary in India
View more details

What Optum employees are saying about work life

based on 3.5k employees
69%
93%
72%
58%
Flexible timing
Monday to Friday
No travel
Night Shift
View more insights

Optum Benefits

Submitted by Company
Job Training
Health Insurance
Soft Skill Training
Cafeteria
Submitted by Employees
Health Insurance
Work From Home
Free Transport
Cafeteria
Job Training
Gymnasium +6 more
View more benefits

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