Clinical Investigator

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Key Responsibilities:

Positions in this function are responsible for investigating, recovering and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities. May include initiating telephone calls to members, providers and other insurance companies to gather coordination of benefits data. Investigate and pursue recoveries and payables on subrogation claims and file management. Process recovery on claims. Ensure adherence to state and federal compli
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
Work is frequently completed without established procedures
Works independently
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 environment, 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 direct

Role Proficiencies:

Medical degree - Bachelor of Homeopathic Medicine and Surgery/ Bachelor of Ayurvedic Medicine and Surgery/ Bachelor of Unani Medicine and Surgery / Bachelor of Physiotherapy / Master of Physiotherapy. Experience Range - 06 months - 3 years. B.Sc. Nursing and Bachelor of Dental Surgery with 1 year of corporate experience. Extensive work experience within own function. Proven attention to detail & Quality focused. Proven good Analytical & comprehension skills.
Preferred Qualifications: Claims processing experience, Health Insurance knowledge, managed care experience. Knowledge of US Healthcare and coding. Medical record familiarity .

Experience:
1 - 3 Years
Salary:
3.5 LPA - 4.5 LPA
Diversity Candidate:
Yes
Location:
Delhi NCR, Bangalore, Chennai, Hyderabad. Pune.
Address:
Delhi NCR, Bangalore, Chennai, Hyderabad. Pune.
Primary Skills:
Medical knowledge, analytical skills, attention to detail, and communication skills, with a strong understanding of medical guidelines, health insurance, and claimsÂ processing.
Industry:
Health/Fitness
Job Type:
Full time
Degree:
Bachelor of Homeopathic Medicine and Surgery/ Bachelor of Ayurvedic Medicine and Surgery/ Bachelor o