India Fraud investigator Jobs – 76 Open Jobs Today

Clinical Investigator
Optum —Noida, Uttar Pradesh
- Full-time
- Microsoft Word
- Medicine
- Microsoft Excel
- Health insurance
Fraud Investigator | International Blended Process
Believer HR —DLF QE, Gurugram, Haryana
- ₹20,000 - ₹35,000 a month
- Full-time
- English
- Analysis skills
- Bachelor's degree
Quick apply
10d
FinCrime Investigator - AML Investigations
Wise —Hyderabad, Telangana
- ₹9,00,000 a year
- Weekend availability
- English
- Analysis skills
- Project management
Quick apply
Trial Attorney (Asset Recovery)
U.S. Department of Justice —Meghalaya
- Part-time
8d
FinCrime Analyst (External Dispute Resolution Investigator)
Revolut —Remote
- ₹2,200 - ₹3,300 a month
- Full-time
- Remote
- English
- Bachelor's degree
Fraud Operations Team Leader
Deliveroo —Hyderabad, Telangana
- Full-time
- Machine learning
- Communication skills
Fraud Analyst-II
Columbia Sportswear Company —Bengaluru, Karnataka
- Weekend availability
- Microsoft Powerpoint
- Microsoft Word
- Microsoft Excel
Insurance Investigation Officer
Gautam Diligent Security Solutions —Madurai, Tamil Nadu
- ₹15,000 - ₹25,000 a month
- Part-time
- Sales
- Business development
- In-person
Quick apply
14h
Senior Process Associate Fraud
Guidehouse India Pvt Ltd —Chennai, Tamil Nadu
- Full-time
- Travel
- Computer networking
- No travel
5d
Private Investigator
CB Singh —Gurugram, Haryana
- Up to ₹15,000 a month
- Hybrid work
- Research
- Analysis skills
- Bachelor's degree
Quick apply
11d
Associate Director, Lending Fraud Risk
Standard Chartered —Bengaluru, Karnataka
- Finance
- Project management
- Bachelor's degree
- Health insurance
- Paid sick time
Asset & Wealth Management Operations - Marcus US Fraud Detections - Analyst - Hyderabad
Goldman Sachs —Hyderabad, Telangana
- Management
- Research
- Bachelor's degree
- Health insurance
Asset & Wealth Management Operations - Marcus US Fraud Detections - Analyst - Bengaluru
Goldman Sachs —Bengaluru, Karnataka
- Management
- Research
- Bachelor's degree
- Health insurance
Associate, Specialist, Fraud Reporting, Legal Compliance and Secretariat
DBS Bank —Mumbai, Maharashtra
- Full-time
- Microsoft Excel
- Finance
- Bachelor's degree
11d
Insurance Investigator - Field Verification
Gautam Diligent Security Solutions —Bangalore City, Bengaluru, Karnataka
- ₹15,000 - ₹25,000 a month
- Part-time
- Sales
- Customer service
- Business development
- Flexible schedule
Quick apply
3d
Marketplace Risk Operations Analyst
StockX —Bengaluru, Karnataka
- SQL
- Analysis skills
- AI
Quick apply
2d
Insurance Investigator
Gautam Diligent Security Solutions —Theni District, Tamil Nadu
- ₹15,000 - ₹25,000 a month
- Part-time
- Sales
- Customer service
- Business development
- Flexible schedule
Quick apply
3d
Senior Process Associate Fraud
Guidehouse —Chennai, Tamil Nadu
- Travel
- Computer networking
- No travel
Senior Clinical Administrative Coordinator - Medical Coding
Optum —Hyderabad, Telangana
- Full-time
- Analysis skills
- Presentation skills
- Bachelor's degree
- Health insurance
DLS Investigator, BRV TIP, DLS Trust and Integrity Program
Amazon Dev Center India - Hyderabad - A85 —Hyderabad, Telangana
- Full-time
- Analysis skills
- Presentation skills
- Bachelor's degree

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Clinical Investigator

Optum -
Noida, Uttar Pradesh

Apply Now

Job details

Full-time

Benefits

Health insurance

Qualifications

Microsoft Word
Medicine
Microsoft Excel
MBBS
BUMS
Analysis skills
Bachelor's degree
CPT coding
BAMS
Communication skills
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/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, 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 & 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/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 - MBBS/BHMS/BAMS/BUMS/BPT/MPT/BDS
Graduate - "Results awaited" candidates will not be accepted
Knowledge of US Healthcare and coding & experience in U.S. healthcare
Proven attention to detail & quality focused
Good knowledge of MS Word & MS Excel

Preferred Qualifications:

Flexibility - Ready to accommodate the working hours and working days depending on the Business Need
Ready to support the business during peak volumes as & when needed
Proven high attention to detail which translates to 100% quality of work performed
Proven good written and verbal communication skills
Proven team player
Proven ability to work independently without close supervision
Proven good analytical skills. He should have the ability to understand the mistakes and correct the same
Ability to work 100% from office

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.

Apply Now

Refine Your Search

fraud investigator jobs in india

Clinical Investigator

Fraud Investigator | International Blended Process

FinCrime Investigator - AML Investigations

Trial Attorney (Asset Recovery)

FinCrime Analyst (External Dispute Resolution Investigator)

Fraud Operations Team Leader

Fraud Analyst-II

Insurance Investigation Officer

Senior Process Associate Fraud

Private Investigator

Associate Director, Lending Fraud Risk

Asset & Wealth Management Operations - Marcus US Fraud Detections - Analyst - Hyderabad

Asset & Wealth Management Operations - Marcus US Fraud Detections - Analyst - Bengaluru

Associate, Specialist, Fraud Reporting, Legal Compliance and Secretariat

Insurance Investigator - Field Verification

Marketplace Risk Operations Analyst

Insurance Investigator

Senior Process Associate Fraud

Senior Clinical Administrative Coordinator - Medical Coding

DLS Investigator, BRV TIP, DLS Trust and Integrity Program

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