Optum Global Solutions walk-in for Clinical Investigator
Company :
Optum Global Solutions
Website :
Job Role :
Clinical Investigator
Eligibility :
BAMS/BHMS/BUMS/BPT/MPT/BDS
Experience :
0 - 4 Years
Job Location :
Gurgaon
Walk-In Date :
11 Jan 2020
Walk-In Time :
09:00 AM Onwards

Company Profile:

We’re a global team of 80,000 people, working collaboratively across the health system to improve care delivery, quality and cost-effectiveness. We focus on three key drivers of transformative change: engaging the consumer, aligning care delivery and modernizing the health system infrastructure.
We are connected with and support important decisions across health care.
We help individuals and families make benefit choices and manage their health care dollars.
We help doctors and patients make informed treatment decisions.
We help communities balance quality health services with sustainable costs.
We create solutions that work together, for the good of the health care system.

Job Description:

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 policiesAdhere to state and federal compliance policies and contract complianceAssist the prospective team with special projects and reporting.

Desired Profile:

Attention to detail and Quality focused.
Good Analytical and comprehension skills.
Claims Processing experience.
Health Insurance knowledge, Managed Care experience.
Knowledge of US Healthcare and Coding.
Medical Record familiarity.

Venue Details:

Optum Global Solutions,
Building No.6, Tower A & B, 5th Floor,
DLF City Phase 3, Gurgaon - 122002.

Contact Person:

Renuka Mann