Join Optum, a global leader in healthcare solutions dedicated to improving lives through advanced technology. We foster an inclusive culture, offering opportunities for growth and development. Our team is committed to optimizing health worldwide, enabling individuals to access the care, pharmacy benefits, data, and resources they need to thrive.

This role focuses on investigating, recovering, and resolving various claims for health plans, commercial clients, and government entities. It involves gathering coordination of benefits data, pursuing subrogation claims, and processing recoveries while ensuring adherence to compliance policies.

Preventing payment of fraudulent or abusive claims using medical expertise, CPT/diagnosis codes, and client-specific guidelines. Ensuring strict adherence to state and federal compliance policies and contract terms. Supporting the team with special projects and reporting. Working independently and potentially coordinating activities for others, often outside established procedures. Complying with all employment contract terms, company policies, and directives, recognizing the company's discretion in policy changes.

A Bachelor's degree in a relevant field, with BHMS, BAMS, BUMS, BPT, B.Sc. Nursing, or BDS preferred. Possession of a Certified Coder certification through AAPCC (CPC only). For non-medical graduates, a minimum of 1+ year of experience in specialty coding (e.g., E&M, surgery, anesthesia, excluding only HCC). For B.Sc. Nursing and BDS graduates, a minimum of 1+ year of corporate experience is required. Demonstrated extensive work experience within your specific function. Proven attention to detail, a strong focus on quality, and excellent analytical and comprehension skills.