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Clinical Investigator

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Optum

Oct 12

Applications are closed

  • Job
    Full-time
    Junior Level
  • Legal
    Healthcare
  • Hyderabad, +1

Requirements

  • Medical degree - BHMS/BAMS/BUMS/BPT/MPT
  • B.Sc Nursing and BDS with 1 year of corporate experience
  • 6+ months of experience (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

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

FAQs

What is the primary role of a Clinical Investigator at Optum?

The primary role involves investigating, recovering, and resolving claims for health plans, commercial customers, and government entities, as well as preventing potentially fraudulent and abusive claims.

What qualifications are required for the Clinical Investigator position?

A medical degree (BHMS/BAMS/BUMS/BPT/MPT), a B.Sc Nursing or BDS with 1 year of corporate experience, and at least 6 months of experience are required, although freshers in relevant fields can also apply.

Is prior experience in claims processing necessary for this role?

While claims processing experience is preferred, it is not strictly necessary, especially for candidates with relevant educational backgrounds.

What skills are important for a Clinical Investigator?

Important skills include attention to detail, quality focus, analytical and comprehension skills, and extensive work experience within the healthcare function.

What does the job entail in terms of compliance?

The job requires adherence to state and federal compliance policies, as well as contract compliance throughout the investigation and claims resolution process.

Are there any preferred qualifications for this position?

Yes, preferred qualifications include claims processing experience, knowledge of health insurance and managed care, familiarity with US Healthcare coding, and medical record familiarity.

What type of work environment can one expect in this position?

The work is frequently completed without established procedures and is often performed independently, but there may also be coordination of activities with others.

Can the Clinical Investigator be involved in special projects?

Yes, the Clinical Investigator may assist the prospective team with special projects and reporting.

What is the company's stance on diversity and inclusion?

Optum values diversity and inclusion, believing that everyone deserves the opportunity to live their healthiest life, and actively works towards mitigating barriers to good health for marginalized groups.

What is the mission of UnitedHealth Group, the parent company of Optum?

The mission is to help people live healthier lives and make the health system work better for everyone, addressing health disparities and improving health outcomes.

Science & Healthcare
Industry
10,001+
Employees

Mission & Purpose

Optum is a health services and technology company that provides a wide range of solutions to improve healthcare delivery and outcomes. They offer services in healthcare management, data analytics, pharmacy benefit management, and technology solutions to healthcare providers, payers, employers, and government agencies. Optum's ultimate mission is to improve the health system's efficiency and effectiveness, creating a healthier world for everyone. Their purpose lies in collaborating with healthcare partners to address complex challenges, such as improving care coordination, reducing healthcare costs, and enhancing patient experiences. By leveraging data-driven insights and innovative technology, Optum aims to empower healthcare professionals and organisations to deliver high-quality, patient-centered care and drive positive healthcare outcomes for individuals and communities worldwide.

Culture & Values

  • Integrity

    Honour commitments. Never compromise ethics.

  • Compassion

    Walk in the shoes of people we serve and those with whom we work.

  • Relationships

    Build trust through collaboration.

  • Innovation

    Invent the future, learn from the past.

  • Performance

    Demonstrate excellence in everything we do.

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