As a Clinical Investigator, you will play a critical role in investigating, recovering, and resolving various claims for health plans, commercial customers, and government entities. Your responsibilities will include initiating phone calls to gather coordination of benefits data, pursuing recoveries and payables on subrogation claims, and ensuring compliance with state and federal policies.
Primary Responsibilities:
- Utilize medical expertise to prevent payment of potentially fraudulent and/or abusive claims.
- Adhere to state and federal compliance policies, reimbursement policies, and contract compliance.
- Assist with special projects and reporting within the prospective team.
- Work independently and frequently without established procedures.
- Act as a resource for others and coordinate activities.
- Comply with employment contracts, company policies, and directives regarding work locations, team changes, and work shifts.
- Adapt to varying company policies and directives as required by the changing business environment.
Required Qualifications:
- Medical degree (BHMS/BAMS/BUMS/BPT/MPT).
- B.Sc Nursing or BDS with 1 year of corporate experience.
- Experience range: 6 months to 3 years (fresh graduates in BPT, MPT, BHMS, BAMS, BUMS are welcome to apply).
- Proven attention to detail and quality focus.
- Strong analytical and comprehension skills.
Preferred Qualifications:
- Experience in claims processing.
- Knowledge of health insurance and managed care.
- Familiarity with US Healthcare and coding.
- Medical record familiarity.