Role & 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 policies
- Adherence to state and federal compliance policies and contract compliance
- Assist the prospective team with special projects and reporting
- May act as a resource for others
- May coordinate others' activities
- 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

Preferred candidate profile

Required Qualifications:

- Medical degree - BHMS/BAMS/BUMS/BPT/MPT




- B.Sc Nursing and BDS with 1 years of corporate experience mandatory
- 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 excellent 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

Role: Clinical Informatics, Industry Type: Analytics / KPO / Research, Department: Healthcare & Life Sciences, Employment Type: Full Time, Permanent Role Category: Health Informatics Education UG: BUMS - Bachelor of Unani Medicine and Surgery in Any Specialization, BHMS - Bachelor of Homeopathic Medicine and Surgery in Any Specialization, Bachelor of Physiotherapy in Any Specialization, BAMS/BNYS in Any Specialization read more

Key Skills BptBHMSMPTBumsPhysiotherapy

📌 Walk-in || Clinical Investigator (New Delhi)
🏢 Optum
📍 New Delhi