Telangana Fraud investigator Jobs – 16 Open Jobs Today

Clinical Investigator
Optum —Hyderabad, Telangana
- Full-time
- B.Sc
- Analysis skills
- Bachelor's degree
- Health insurance
FinCrime Investigator - AML Investigations
Wise —Hyderabad, Telangana
- ₹9,00,000 a year
- Weekend availability
- English
- Analysis skills
- Project management
Quick apply
Fraud Operations Team Leader
Deliveroo —Hyderabad, Telangana
- Full-time
- Machine learning
- Communication skills
Asset & Wealth Management Operations - Marcus US Fraud Detections - Analyst - Hyderabad
Goldman Sachs —Hyderabad, Telangana
- Management
- Research
- 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
Senior Clinical Administrative Coordinator - Medical Coding
Optum —Hyderabad, Telangana
- Full-time
- Analysis skills
- Presentation skills
- Bachelor's degree
- Health insurance
Private Investigator
Ingenious Ideas —Hyderabad, Telangana
- ₹15,000 - ₹30,000 a month
- Part-time
- In-person
Quick apply
Risk Specialist I, SPIV
ADCI HYD 20 SEZ - H94 —Hyderabad, Telangana
- Full-time
- Computer science
- Finance
- SQL
Program Manager II, Program Manager II, Shared Services
ADCI HYD 20 SEZ - H94 —Hyderabad, Telangana
- Full-time
- Microsoft Excel
- SQL
- Project management
4d
Program Manager I, DPWI, Selling Partner Services
ADCI - Karnataka - A66 —Hyderabad, Telangana
- Full-time
- Microsoft Excel
- SQL
- Machine learning
Sr. AI Risk Manager , Res-Q
Amazon Dev Center India - Hyderabad - A85 —Hyderabad, Telangana
- Full-time
- Data analysis skills
- SQL
- Machine learning
Data Scientist II, Forecasting, Demand Planning and Workforce Intelligence
ADCI - Karnataka —Hyderabad, Telangana
- Full-time
- SQL
- Machine learning
- Scripting
Support Engineer II-Ext
Amazon Dev Center India - Hyderabad - A85 —Hyderabad, Telangana
- Full-time
- Computer Science
- SQL
- Analysis skills
Business Intelligence Engineer II
ADCI HYD 13 SEZ —Hyderabad, Telangana
- Full-time
- Oracle
- SQL
- AWS
EXECUTIVE
Bachpan Bachao Andolan —Hyderabad, Telangana
- Online application
- Microsoft Excel
- English
- Research

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FinCrime Investigator - AML Investigations
Wise —Hyderabad, Telangana
Customer Communication: Communicate clearly, professionally, and empathetically with customers via approved channels to obtain necessary details or…
₹9,00,000 a year
Quick apply
FinCrime Operations Team Lead - AML Investigations
Wise —Hyderabad, Telangana
Develop effective operational processes, task allocation, training and performance management to deliver regulatory obligations, risk management, quality…
From ₹17,00,000 a year
Quick apply

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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.

Apply Now

Refine Your Search

fraud investigator jobs in telangana

Clinical Investigator

FinCrime Investigator - AML Investigations

Fraud Operations Team Leader

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

DLS Investigator, BRV TIP, DLS Trust and Integrity Program

Senior Clinical Administrative Coordinator - Medical Coding

Private Investigator

Risk Specialist I, SPIV

Program Manager II, Program Manager II, Shared Services

Program Manager I, DPWI, Selling Partner Services

Sr. AI Risk Manager , Res-Q

Data Scientist II, Forecasting, Demand Planning and Workforce Intelligence

Support Engineer II-Ext

Business Intelligence Engineer II

EXECUTIVE

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