Clinical Investigator – Claims (Freshers & Experienced)

About the role

Optum is seeking a Clinical Investigator for its Claims division in Gurgaon, India. The role focuses on investigating medical claims, preventing fraudulent payments, and ensuring regulatory compliance. It is suitable for fresh graduates as well as candidates with limited experience in healthcare or claims.

Key responsibilities

• Investigate healthcare claims to identify potentially fraudulent payments.
• Review medical records using clinical knowledge and established guidelines.
• Ensure compliance with state and federal regulations.
• Process claims recovery activities.
• Coordinate with healthcare providers and members.
• Assist with reporting and special projects.
• Support colleagues as a clinical resource.
• Coordinate team activities for effective workflow.
• Maintain compliance with organisational policies and quality standards.

Required profile

• Educational qualifications: BHMS, BAMS, BUMS, BPT, MPT, BDS (1+ year corporate experience preferred).
• Freshers are eligible to apply; 6+ months of relevant experience is preferred.
• Strong clinical knowledge for reviewing medical records.
• Understanding of claims processes and fraud prevention.
• Ability to work collaboratively with internal teams and external providers.

Required skills