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 workplace, 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

Qualifications - External

Required Qualifications
Medical degree - BHMS/BAMS/BUMS/BPT/MPT. B.Sc Nursing and BDS
CPC Certification




6+ months of experience (Fresher's in BPT / MPT / BHMS/ BAMS/ BUMS can also apply)
Extensive work experience within own function
Proven attention to detail & quality focused
Proven positive 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 workplace and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

📌 Clinical Investigator Hyderabad (India)
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📍 India