Are you ready to make a difference in the healthcare industry? Optum, a leader in healthcare innovation and a key part of the UnitedHealth Group, is offering a promising opportunity for aspiring Clinical Investigators. With a commitment to improving health equity and integrating advanced technology into healthcare delivery, Optum is seeking dedicated individuals like you to join their diverse and inclusive workplace.
What is the Role of a Clinical Investigator?
As a Clinical Investigator at Optum, you will play a pivotal role in safeguarding the integrity of healthcare claims. Your mission will be to identify and prevent fraudulent activities while ensuring the delivery of quality care. Here are some of the key responsibilities you’ll undertake in this crucial position:
- Claims Investigation: You’ll investigate and resolve claims for health plans, commercial customers, and government entities, ensuring that all healthcare claims are handled accurately and ethically.
- Thorough Medical Review: Conducting comprehensive reviews of medical histories and contestable investigations will be essential to your role. Your medical expertise will guide your assessments.
- Utilizing Medical Knowledge: Understanding CPT and diagnosis codes, as well as client-specific guidelines, will enable you to effectively analyze claims.
- Supporting Special Projects: You’ll assist with special projects and reporting tasks for your team, enhancing overall operational efficiency.
- Adherence to Compliance: Ensuring compliance with state and federal regulations, contract guidelines, and reimbursement policies is non-negotiable in maintaining the integrity of claims processing.
- Quality Focus: A strong attention to detail and commitment to quality is expected as you independently handle tasks and coordinate activities.
Qualifications for the Clinical Investigator Position
To thrive at Optum as a Clinical Investigator, candidates must meet the following qualifications:
Required Qualifications:
- A medical degree such as BHMS, BAMS, BUMS, BPT, or MPT.
- A B.Sc Nursing or a BDS degree with a minimum of 1 year of corporate experience.
- Experience ranging from 6 months to 3 years is preferred, but fresh graduates in BPT, MPT, BHMS, BAMS, or BUMS are encouraged to apply.
Preferred Qualifications:
- Experience in claims processing, managed care, or health insurance will be advantageous.
- Familiarity with US healthcare systems and medical coding is highly desired.
- A solid understanding of medical records and healthcare terminology will set you apart from the competition.
Key Skills Required
Successful Clinical Investigators possess a blend of the following skills:
- Analytical Abilities:Â Proven analytical skills are essential for examining claims and identifying discrepancies.
- Attention to Detail:Â A strong focus on quality and detail-oriented work ensures accuracy in all investigations.
- Independent & Team Work: While you’ll often work independently, being a team player is crucial for collaborating on projects.
- Compliance Knowledge:Â Familiarity with healthcare compliance standards is a must.
- Adaptability:Â The nature of the job may require you to adapt to various roles and responsibilities depending on business needs.
Why Join Optum?
Optum offers its employees a chance to grow their careers within a supportive and inclusive environment. By joining this innovative organization, you’ll not only contribute to significant healthcare advancements but also enjoy comprehensive benefits and development opportunities. Your work can impact communities on a global scale, making this role not just a job, but a chance to make a real difference.
