UnitedHealth Group

Clinical Investigator - Hyderabad, Tg

3+ months agoHyderabad, India

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

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.

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


Required Qualifications:
  • Medical degree: BHMS / BAMS / BUMS / BPT / MPT / Nursing
  • Experience Range: 0-4 years (Freshers can apply)
  • Attention to detail and quality focused
  • Good analytical and comprehension skills


Preferred Qualifications:
  • Managed care experience
  • Claims processing experience
  • Health Insurance knowledge
  • Knowledge of US Healthcare and coding
  • Medical record familiarity


Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Job Keywords: Clinical Investigator, Fresher, US Healthcare, Healthcare, Health Care, Hyderabad, TG, Telangana

Job ID: UHG-915780