Optum is hiring for Clinical Investigator positions across Noida, Delhi NCR, and Ghaziabad. This is a major healthcare opportunity with 151 openings for candidates with medical backgrounds, CPC certification, medical coding expertise, and knowledge of healthcare claims.
The Optum Clinical Investigator job focuses on investigating, recovering, and resolving healthcare claims while helping identify potentially fraudulent or abusive claims. Candidates with expertise in CPT codes, diagnosis codes, medical coding, claims processing, and US healthcare may find this opportunity particularly relevant.
Job Details
| Job Detail | Information |
|---|---|
| Company | Optum |
| Job Role | Clinical Investigator |
| Experience | 0โ5 Years |
| Openings | 151 |
| Job Location | Noida, Delhi NCR, Ghaziabad |
| Employment Type | Full-Time, Permanent |
| Industry | Healthcare & Life Sciences / Analytics |
| Certification | CPC (AAPC) Required |
| Salary | Not Disclosed |
About the Optum Clinical Investigator Role
The Clinical Investigator at Optum will work on healthcare claims investigation and resolution activities. The role involves applying medical knowledge and medical coding expertise to review claims, identify potential fraud or abuse, and ensure compliance with applicable policies.
Professionals may also investigate claims, coordinate with members and providers, review medical information, support recoveries, and assist with reporting and special projects.
This opportunity can be suitable for CPC-certified medical coding professionals, healthcare graduates, nursing professionals, physiotherapy graduates, and medical graduates with relevant experience.
Key Responsibilities
The selected candidates may be responsible for:
- Investigating, recovering, and resolving healthcare claims.
- Identifying potentially fraudulent and abusive claims using medical expertise.
- Reviewing CPT codes and diagnosis codes.
- Applying medical coding knowledge and client-specific guidelines.
- Ensuring compliance with state, federal, reimbursement, and contract policies.
- Investigating and pursuing claim recoveries and payables.
- Gathering coordination of benefits information from relevant stakeholders.
- Reviewing medical history during applicable investigations.
- Supporting claims processing and recovery activities.
- Assisting teams with special projects and reporting.
- Working independently on complex assignments.
- Supporting or coordinating activities with other team members.
Required Qualifications
Candidates should meet the following requirements:
- Any Graduate qualification.
- Medical and healthcare graduates may be preferred.
- BHMS / BAMS / BUMS / BPT / MPT candidates may be considered.
- B.Sc Nursing and BDS candidates with at least 1 year of corporate experience may be eligible.
- AAPC certification is mandatory.
- Only CPC certification is accepted, according to the provided job description.
- Candidates should have relevant medical coding experience.
Medical Coding Experience
Candidates who are not medical graduates should have more than one year of experience in specialty coding.
Relevant specialty coding experience may include:
- E&M Coding
- Surgery Coding
- Anesthesia Coding
The listing indicates that experience exclusively in HCC coding may not meet the preferred specialty coding requirement.
Required Skills
The ideal candidate should have knowledge of:
- Medical Coding
- CPC Certification
- CPT Codes
- Diagnosis Codes
- Healthcare Claims
- Claims Investigation
- Claims Processing
- Clinical Operations
- US Healthcare
- Health Insurance
- Managed Care
- Medical Records
- Compliance
- Analytical Skills
- Attention to Detail
Preferred Qualifications
The following experience may be advantageous:
- Healthcare claims processing experience.
- Health insurance knowledge.
- Managed care experience.
- Understanding of the US healthcare system.
- Knowledge of medical coding guidelines.
- Familiarity with medical records.
- Strong analytical and comprehension skills.
- Quality-focused work experience.
Benefits and Career Opportunities
According to the job description, Optum highlights:
- Career development opportunities.
- A diverse and inclusive work environment.
- Opportunities to work with healthcare and technology-driven teams.
- Exposure to healthcare data and claims operations.
- Opportunities to contribute to health outcomes and healthcare operations.
- Comprehensive employee benefits, subject to applicable company policies.
Actual benefits, compensation, and employment terms should be confirmed directly with Optum during the recruitment process.
Who Should Apply?
This Optum Clinical Investigator job may be suitable for:
- CPC-certified medical coders.
- BHMS graduates.
- BAMS graduates.
- BUMS graduates.
- BPT and MPT graduates.
- B.Sc Nursing professionals.
- BDS graduates with relevant corporate experience.
- Healthcare professionals with claims processing experience.
- Professionals with US healthcare and managed care knowledge.
Candidates with strong knowledge of medical coding, CPT codes, diagnosis codes, healthcare claims, and compliance may have an advantage.
Salary for Clinical Investigator at Optum
The salary for this position has been listed as Not Disclosed.
Based on the role, required CPC certification, healthcare domain knowledge, and relevant experience, a broad estimated market range could be approximately:
โน3,00,000 โ โน8,00,000 per annum
Disclaimer: This is an independent market estimate for informational purposes only and is not an officially disclosed salary from Optum. Actual compensation may vary based on experience, skills, location, and company policies.
How to Apply
