CALL RATI 9211611949 15 JULY MEGA WALKIN FOR CLINICAL INVESTIGATOR IN UNITED HEALTH GROUP(OPTUM)NOIDA/BHMS/BAMS/BUMS/BPT/MPT/BDS ANY/SALARY FRESHER UP TO 2.4 LPA/EXPERIENCED 5 LPA
POSITION CLININCAL INVESTIGATOR
SAL FOR FRESHER UPTO 2.4 LPA
EXPERIENCED UP TO 5 LPA
Purpose of Job
This process works on identifying discrepancies between medical records and billed services for complex and high value claims by identifying Up-coding, Unbundling, Duplication, and Misrepresentation of services. They approve/deny claims & Identify provider aberrant behavior patterns. The associates 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
-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
Medical degree - BHMS/BAMS/BUMS/BPT/MPT
0 to 3 years of overall experience (Freshers can apply)
Job Description :
To ensure customer service and support all operations. To create customer delight at every interaction.
Interacting with external customers and internal customers and addressing their queries, requests and complaints.
Committed TATs are met consistently
Complaints Management- addressing customer complaints at the branch, system updation, coordination with Sales/HUB/ other functions for resolution.
Refunds processing and dispatch
Undelivered policy documents tracking and management.
Maintenance of all files and registers.
New Business Processing:-
Handling end to end New business processing starting from creation of Client id,Case start up, New business login, Follow up for policy issuance, Quality Check
Follow up with HUB for policy issuance of pending cases