Are you a certified professional coder (CPC) with a passion for healthcare claims investigation? Optum, a leading global health organization, is hiring a Clinical Investigator CPC Certified in Noida, Uttar Pradesh, India. This role focuses on preventing fraudulent claims, reviewing medical records, and ensuring compliance in health plans. If you have a medical degree and CPC certification, this opportunity lets you make a real impact on patient care while advancing your career in claims processing.
Key Responsibilities
As a Clinical Investigator CPC Certified at Optum, you’ll play a crucial role in claims management. Your duties include:
- Investigating and resolving claims for health plans, commercial customers, and government entities.
- Preventing payment of potentially fraudulent or abusive claims using medical expertise, CPT/diagnosis codes, and CMC guidelines.
- Reviewing prepay claims with medical records to verify payment accuracy.
- Participating in regulatory meetings, provider discussions, and legal consultations.
- Monitoring claim inventory, conducting contestable investigations, and handling special projects.
- Ensuring adherence to state and federal compliance policies, reimbursement guidelines, and contract terms.
- Working independently on complex tasks without established procedures.
This position involves analyzing data, coordinating with stakeholders, and contributing to health optimization initiatives.
Required Qualifications
To qualify for this Clinical Investigator CPC Certified job in Noida, you need:
- A medical degree such as BHMS, BAMS, BUMS, BPT, MPT, or B Pharma/M Pharma.
- Certified Professional Coder (CPC) certification from AAPC.
- Experience with CPT and ICD coding, or the ability to pass AAPC CPC certification.
- At least 6 months as an experienced certified coder.
- Alternatively, B.Sc. Nursing or BDS with 1 year of corporate experience.
- Extensive work experience in claims processing, with strong attention to detail, analytical skills, and quality focus.
Preferred Qualifications
Optum prefers candidates with:
- Claims processing experience in health insurance.
- Knowledge of US healthcare systems, managed care, and medical records.
- Familiarity with coding and reimbursement policies.
Benefits of Working at Optum
Optum offers a supportive culture with inclusion, talented peers, and comprehensive benefits. You’ll enjoy career development opportunities, competitive compensation, and the chance to improve health outcomes globally. This role supports work-life balance and contributes to equitable care initiatives.