Optum
Job Description
Purpose of Job – Clinical Investigator
This process works on identifying discrepancies between medical records and billed services for complex and high value claims by identifying Up-coding, Unbundling, Duplication, and Misrepresentation of services. They approve/deny claims & Identify provider aberrant behavior patterns. The associates prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/ diagnosis codes, CMC guideline along with referring to client specific guidelines and member policies.
This process works on identifying discrepancies between medical records and billed services for complex and high value claims by identifying Up-coding, Unbundling, Duplication, and Misrepresentation of services. They approve/deny claims & Identify provider aberrant behavior patterns. The associates prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/ diagnosis codes, CMC guideline along with referring to client specific guidelines and member policies.
Job Responsibilities
-Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/diagnosis codes , CMC guideline along with referring to client specific guidelines and member policies
-Adherence to state and federal compliance policies and contract compliance
-Assist the prospective team with special projects and reporting
-Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/diagnosis codes , CMC guideline along with referring to client specific guidelines and member policies
-Adherence to state and federal compliance policies and contract compliance
-Assist the prospective team with special projects and reporting
VENUE DETAILS
15th July-09:30 A.M
UnitedHealth Group Information Services
Ground Floor
Tower D, 3Cs Oxygen SEZ,
Sector 144, Noida, Uttar Pradesh
Contact Person: Aakash Chaudhary
Ground Floor
Tower D, 3Cs Oxygen SEZ,
Sector 144, Noida, Uttar Pradesh
Contact Person: Aakash Chaudhary
Salary: INR 1,25,000 – 4,50,000 P.A. Best in the Industry
Industry: BPO / Call Centre / ITES
Functional Area: Medical, Healthcare, R&D, Pharmaceuticals, Biotechnology
Role Category: Medical Professional
Role: Medical Officer
Employment Type: Permanent Job, Full Time
