UnitedHealth Group (Optum) is hiring for the position of Clinical Investigator in Hyderabad, Telangana. This opportunity is listed under the Claims job category and is focused on identifying potentially fraudulent or abusive healthcare claims using medical knowledge, coding expertise, CPT and diagnosis codes, and CMS guidelines.
Candidates with medical qualifications, AAPC Certified Professional Coder (CPC) certification, and relevant experience in specialty medical coding can apply.
Job Details
| Particulars | Details |
|---|---|
| Company | UnitedHealth Group (Optum) |
| Job Role | Clinical Investigator |
| Job Category | Claims |
| Job Location | Hyderabad, India |
| Requisition Number | 2397884 |
| Date Posted | 5 November 2026 |
| Experience | 1+ years for specified eligibility categories |
| Qualification | Any Graduate / BHMS / BAMS / BUMS / BPT / MPT / B.Sc. Nursing / BDS |
| Certification | AAPC CPC |
| Travel | No |
| Application Mode | Online |
Position: Clinical Investigator
UnitedHealth Group is looking for a Clinical Investigator to review healthcare claims and help prevent payments associated with potentially fraudulent or abusive claims.
The role involves applying medical expertise, understanding CPT and diagnosis codes, following CMS guidelines, and ensuring compliance with client-specific guidelines, member policies, and applicable regulations.
Key Responsibilities
- Identify and prevent payments for potentially fraudulent or abusive healthcare claims.
- Apply medical expertise and knowledge of CPT and diagnosis codes during claim reviews.
- Refer to CMS guidelines, client-specific guidelines, and member policies.
- Ensure adherence to state and federal compliance policies and contractual requirements.
- Support the prospective team with special projects and reporting activities.
- Coordinate with team members and communicate recent process-related updates.
- Follow applicable company policies, procedures, and business directives.
Eligibility Criteria and Qualifications
Candidates should meet the educational and professional requirements mentioned below.
Educational Qualifications:
- Any Graduate.
- BHMS (Bachelor of Homeopathic Medicine and Surgery).
- BAMS (Bachelor of Ayurvedic Medicine and Surgery).
- BUMS (Bachelor of Unani Medicine and Surgery).
- BPT (Bachelor of Physiotherapy).
- MPT (Master of Physiotherapy).
- B.Sc. Nursing.
- BDS (Bachelor of Dental Surgery).
Experience and Certification Requirements:
- B.Sc. Nursing and BDS candidates must have at least 1 year of corporate experience.
- Candidates must hold an AAPC Certified Professional Coder (CPC) certification.
- Candidates who are not medical graduates must have at least 1 year of experience in specialty coding, such as E&M, surgery, or anesthesia.
- Experience limited to HCC coding alone does not meet the stated specialty coding requirement.
Required Skills
Candidates should demonstrate the following skills:
- Strong analytical and comprehension skills.
- Excellent attention to detail.
- Quality-focused approach to work.
- Medical knowledge and familiarity with healthcare records.
- Understanding of CPT and diagnosis codes.
- Knowledge of CMS guidelines.
- Specialty medical coding expertise.
Preferred Qualifications
The following experience and knowledge will be advantageous:
- Claims processing experience.
- Health insurance knowledge.
- Managed care experience.
- Understanding of the US healthcare system and medical coding.
- Familiarity with medical records.
