Join Optum, a global leader dedicated to improving health outcomes through innovative technology and compassionate care. We empower millions to live healthier lives by connecting them with essential health resources. Our inclusive culture fosters collaboration with talented peers, offers comprehensive benefits, and provides ample career development opportunities. Contribute to advancing health optimization worldwide and be a part of our mission to Care, Connect, and Grow together.

Investigate, recover, and resolve diverse claims for health plans, commercial clients, and government entities. This includes initiating contact with members, providers, and other insurance companies to gather coordination of benefits information. Pursue recoveries and payables on subrogation claims, manage case files, and process claim recoveries. Ensure strict adherence to state and federal compliance policies, reimbursement guidelines, and contract stipulations.

Key duties involve preventing fraudulent or abusive claims using medical expertise, CPT/diagnosis codes, and CMC guidelines. You will also follow client-specific protocols and member policies, assist with special projects and reporting, and potentially act as a resource or coordinate team activities. All actions must comply with employment agreements, company policies, and directives, adapting to evolving business needs.

This role requires a medical degree such as BHMS, BAMS, BUMS, BPT, MPT, B.Sc Nursing, or BDS, coupled with a mandatory 1+ year of corporate experience. Alternatively, candidates with 6+ months of experience are welcome, and freshers holding a BPT, MPT, BHMS, BAMS, or BUMS degree may also apply.

Exceptional candidates will possess extensive experience within their functional area, demonstrate proven attention to detail and a focus on quality, and exhibit strong analytical and comprehension skills. The ability to work independently is also crucial for success in this position.