UnitedHealth Group is dedicated to empowering individuals to lead healthier lives and optimizing the healthcare system for all. We recognize that disparities in health outcomes persist, particularly for marginalized communities. This role plays a crucial part in our mission to address these challenges and promote equitable care.

This position focuses on the critical task of preventing fraudulent and abusive claims through expert medical review. You will leverage your clinical knowledge and understanding of coding systems, regulatory guidelines, and client-specific policies to ensure accurate claim adjudication.

We foster a collaborative environment where team members share updates and contribute to special projects. Adherence to employment contracts, company policies, and directives is paramount, ensuring flexibility and adaptability in a dynamic business landscape.

Prevent the payment of potentially fraudulent and/or abusive claims by applying medical expertise, knowledge of CPT and diagnosis codes, and CMS guidelines.

Adhere strictly to client-specific guidelines, member policies, and state and federal compliance regulations.

Collaborate with team members to support special projects and reporting initiatives.

Coordinate with the entire team, sharing recent process-related updates and best practices.

Comply with all terms of the employment contract, company policies, and directives, including potential changes in work location, teams, or shifts.

A graduate degree is required, with a preference for BHMS, BAMS, BUMS, BPT, MPT, B.Sc. Nursing, or BDS.

Candidates with B.Sc. Nursing or BDS require at least 1 year of corporate experience. A certified coder through AAPC (CPC Only) is essential.

For non-medical graduates, a minimum of 1 year of experience in specialty coding (e.g., E&M, surgery, anesthesia) is necessary, excluding solely HCC coding.

Proven extensive work experience within your functional area, coupled with meticulous attention to detail and a strong quality focus, is expected.

Excellent analytical and comprehension skills are fundamental to this role. For those with a medical degree (BHMS/BAMS/BUMS/BPT/MPT, B.Sc Nursing, BDS), CPC certification is required, and 6+ months of experience is beneficial. Freshers in BPT/MPT/BHMS/BAMS/BUMS are encouraged to apply. A proven ability to work independently is also key.