Conduct thorough investigations into complex medical cases using strong analytical and problem-solving skills.
Interpret and apply CPT guidelines, reimbursement policies, contracts, and clinical rules for claim review.
Review pre-payment claims with medical records to assess accuracy and compliance.
Participate in regulatory and client meetings to discuss clinical review findings and process improvements.
Engage with providers, advocates, and legal teams to support resolution and reduce provider abrasion.
Analyze data and support special projects, reporting, and operational enhancements.

Job Requirements

Certified Professional Coder (CPC) certification is mandatory.
Strong knowledge of CPT and ICD coding principles and practices.
Excellent communication and interpersonal skills are required for effective collaboration with cross-functional teams.
Ability to work independently with minimal supervision and prioritize tasks effectively.
Strong attention to detail and quality-driven approach to ensure high-quality results.
Experience in claims processing and understanding of health insurance processes.
Educational background: BHMS / BAMS / BUMS or BPT / MPT or B.Sc Nursing or BDS (with at least one year of corporate experience).

About Company

Optum, part of UnitedHealth Group, is a global healthcare organization delivering technology-enabled care solutions. We focus on improving access to quality care, reducing healthcare disparities, and advancing equity across healthcare systems.

Disclaimer: This job description has been sourced from a public domain and may have been modified by Naukri.com to improve clarity for our users. We encourage job seekers to verify all details directly with the employer via their official channels before applying.

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Senior Clinical Inv