Hyderabad Telangana Claim investigator Jobs – 5 Open Jobs Today

Clinical Investigator
Optum —Hyderabad, Telangana
- Full-time
- B.Sc
- Analysis skills
- Bachelor's degree
- Health insurance
Private Investigator
Ingenious Ideas —Hyderabad, Telangana
- ₹15,000 - ₹30,000 a month
- Part-time
- In-person
Quick apply
Senior Clinical Administrative Coordinator - Medical Coding
Optum —Hyderabad, Telangana
- Full-time
- Analysis skills
- Presentation skills
- Bachelor's degree
- Health insurance
Clinical Research Associate - II
AXIS Clinicals —Miyapur, Hyderabad, Telangana
- Full-time
- Up to 50% travel
- English
- Master's degree

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Private Investigator
Ingenious Ideas —Hyderabad, Telangana
Their role involves gathering information, conducting surveillance, verifying facts, and preparing detailed reports to assist clients in making informed…
₹15,000 - ₹30,000 a month
Quick apply
Complaints Investigator
DIFGEN PHARMACEUTICALS PRIVATE LIMITED —Kukatpally, Hyderabad, Telangana
Diploma in Pharmacy (D.Pharm), Bachelor of Pharmacy (B.Pharm), B.Sc. in Life Sciences, Chemistry, Microbiology, Biotechnology, or related scientific discipline…

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Clinical Investigator

Optum -
Hyderabad, Telangana

Apply Now

Job details

Full-time

Benefits

Health insurance

Qualifications

B.Sc
BUMS
Analysis skills
Science
Medical records
Bachelor's degree
CPT coding
BAMS
Nursing
MPT

Full job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

This process works on identifying Fraud, Waste and Abuse between medical records and billed services for complex and high value claims by identifying Up-coding, Unbundling, Duplication, and Misrepresentation of services. They approve or deny claims and Identify provider aberrant behavior patterns. The associates prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT or diagnosis codes, CMS guideline along with referring to client specific guidelines and member policies.

Fraud is intentionally misrepresenting or concealing facts to obtain something of value. The complete definition has three primary components:

Intentional dishonest action or misrepresentation of fact
Committed by a person or entity
With knowledge that dishonest action or misrepresentation could result in an inappropriate gain or benefit

This definition applies to all persons and all entities. However, there are special rules around intentional misrepresentations to Government programs such as Medicare and Medicaid, or TRICARE.

Waste includes inaccurate payments for services, such as unintentional duplicate payments, and can include inappropriate utilization and/or inefficient use of resources.

Abuse includes any practice that results in the provision of services that:

Are not medically necessary
Do not meet professionally recognized standards for health care
Are not fairly priced

Primary Responsibilities:

Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT or diagnosis codes, CMS 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
Coordinate with all team members and share recent process related updates
Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

Medical degree - BHMS/BAMS/BUMS/BPT/MPT
B.Sc Nursing and BDS with 1+ years of corporate experience
6+ months of experience (Fresher's in BPT / MPT / BHMS/ BAMS/ BUMS can also apply)
CPC Certification Mandate.
Extensive work experience within own function
Proven attention to detail & quality focused
Proven good analytical & comprehension skills
Proven ability to work independently

Preferred Qualifications:

Claims processing experience
Health Insurance knowledge, managed care experience
Knowledge of US Healthcare and coding
Medical record familiarity

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

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claim investigator jobs in hyderabad telangana

Clinical Investigator

Private Investigator

Senior Clinical Administrative Coordinator - Medical Coding

Clinical Research Associate - II

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