Eligibility Criteria

Freshers

- Candidates must possess a Clinical Degree in any of the following:
- BPT / MPT
- B.Sc Nursing / M.Sc Nursing
- BHMS
- BUMS
- BAMS
- BDS
- CPC Certification (AAPC) is Mandatory.

Role Summary

This role is responsible for investigating, recovering, and resolving various types of healthcare claims for health plans, commercial customers, and government entities. Responsibilities include coordination of benefits, subrogation claims, claims recovery, medical investigations, compliance adherence, and review of complex medical claims, including transplant cases.

Key Responsibilities

- Investigate and prevent potentially fraudulent or abusive claims using medical expertise and CPT/Diagnosis coding knowledge.
- Ensure adherence to state, federal, reimbursement, and contract compliance policies.
- Review client-specific guidelines, member policies, and CMC guidelines.
- Investigate, recover, and resolve healthcare claims.
- Support special projects and reporting activities.
- Work independently while maintaining high quality and accuracy.




- Coordinate activities and act as a resource for team members when required.
- Comply with company policies, employment terms, work location flexibility, shift changes, and business requirements.

Required Qualifications

- Any Graduate (Clinical Degrees Preferred: BHMS, BAMS, BUMS, BPT, MPT)
- B.Sc Nursing and BDS candidates must have 1 year of corporate experience.
- AAPC CPC Certification is Mandatory (Only CPC accepted).
- Experienced candidates (non-medical graduates) must have 1+ year of specialty coding experience in areas such as:
- E&M;
- Surgery
- Anesthesia
- Other specialty coding (HCC-only experience is not sufficient)
- Robust analytical, comprehension, and attention-to-detail skills.
- Quality-focused with relevant functional experience.

Preferred Qualifications

- Claims Processing Experience
- Health Insurance / Managed Care Experience
- Knowledge of US Healthcare and Medical Coding
- Familiarity with Medical Records

📌 Clinical Investigator (Chennai)
🏢 Vdart Software Services Private
📍 Chennai