Optum, a part of UnitedHealth Group, is a global leader in healthcare innovation, delivering care through advanced technology. With a mission to improve health outcomes, Optum connects millions with better healthcare resources, pharmacy benefits, and data-driven solutions. The company fosters an inclusive work culture with career growth opportunities, comprehensive benefits, and a commitment to equitable healthcare.
Detailed Job Description
Job Title: Clinical Investigator
Requisition Number: 2299523
Location: Gurgaon, Haryana
Job Category: Claims
Key Responsibilities:
- Investigate, recover, and resolve healthcare claims for health plans, commercial clients, and government entities.
- Prevent fraudulent/abusive claims using medical expertise, CPT/diagnosis codes, and CMC guidelines.
- Coordinate with members, providers, and insurers for claims subrogation and COB (Coordination of Benefits).
- Ensure compliance with state/federal regulations and client-specific policies.
- Assist in fraud detection, large claims monitoring (e.g., transplant cases), and special projects.
- Work independently with strong attention to detail and analytical skills.
Eligibility Criteria
Required Qualifications:
- Medical Degree: BHMS / BAMS / BUMS / BPT / MPT
- B.Sc Nursing / BDS with 1+ years of corporate experience
- Freshers (BPT/MPT/BHMS/BAMS/BUMS) can apply
- Strong analytical & comprehension skills
- Ability to work independently
Preferred Qualifications:
- Experience in claims processing or health insurance
- Knowledge of US healthcare systems & medical coding
- Familiarity with medical records & managed care
Benefits of Working at Optum
✅ Global Healthcare Impact – Improve patient outcomes worldwide
✅ Career Growth – Learning & development opportunities
✅ Inclusive Work Culture – Diversity-driven workplace
✅ Comprehensive Benefits – Health, wellness, and financial plans
✅ Flexible Work Policies – Adaptable work arrangements
How to Apply
