Optum, part of UnitedHealth Group, is inviting applications for the position of Clinical Investigator in Noida, Uttar Pradesh. The opportunity is listed under the Claims department and is suitable for eligible healthcare graduates and medical coding professionals with relevant experience in claims investigation, medical records, and healthcare coding.
The role focuses on identifying potentially fraudulent or abusive medical claims, reviewing medical information, applying relevant coding knowledge, and ensuring compliance with reimbursement policies and contractual requirements. The selected candidate may also support reporting activities and special projects while working independently on assigned investigations.
Candidates with qualifications such as BHMS, BAMS, BUMS, BPT, MPT, Nursing, or BDS, as applicable to the listed criteria, may consider applying. Certified professional coders with the specified credentials and relevant experience may also be eligible.
Optum Clinical Investigator Recruitment 2026: Job Highlights
| Particulars | Details |
|---|---|
| Company | Optum / UnitedHealth Group |
| Job Title | Clinical Investigator |
| Requisition Number | 2389227 |
| Job Category | Claims |
| Job Location | Noida, Uttar Pradesh, India |
| Experience | More than 1 year for the specified non-medical-graduate pathway |
| Qualification | Relevant healthcare degree or specified coding certification |
| Work Arrangement | Not specified in the supplied listing |
| Travel Requirement | No |
| Overtime Status | Exempt |
| Salary | Not disclosed |
| Application Mode | Online |
About Optum
Optum is a global healthcare organization that combines healthcare services, technology, pharmacy benefits, data, and resources to help people access and manage their healthcare needs.
As part of UnitedHealth Group, Optum works across different areas of the healthcare system, including healthcare operations, claims, and services intended to improve health outcomes.
Job Description: Clinical Investigator
The Clinical Investigator role is part of Optum’s claims function. The position involves reviewing claims for potential fraud, abuse, or inappropriate payments by using medical knowledge, diagnosis and procedure codes, applicable guidelines, and client-specific policies.
The investigator must assess relevant information carefully, follow compliance requirements, and support accurate claims decisions. The role may also involve independent investigations, reporting, and collaboration with other teams on special projects.
Key Responsibilities
1. Medical Claims Investigation
- Review medical claims to identify potentially fraudulent, abusive, or inappropriate payment requests.
- Use medical knowledge and relevant procedure and diagnosis codes to assess claims.
- Apply applicable guidelines, client-specific requirements, and member policies.
- Review medical information and supporting documentation when investigating claims.
2. Coding and Medical Record Review
- Apply relevant knowledge of medical coding, including CPT and diagnosis codes.
- Use coding guidelines to support accurate claim assessments.
- Examine available medical records and supporting information where required.
- Identify discrepancies or other concerns that may require further investigation.
3. Compliance and Policy Adherence
- Follow applicable state and federal compliance requirements.
- Adhere to reimbursement policies, contractual requirements, and company procedures.
- Ensure investigations are handled carefully and consistently with relevant guidelines.
- Maintain a quality-focused approach to claims review.
4. Reporting and Project Support
- Assist the prospective team with special projects and reporting activities.
- Work independently on assigned tasks, including cases that may not have fully established procedures.
- Serve as a resource for colleagues when appropriate.
- Coordinate activities with other team members when required.
Eligibility Criteria
The supplied vacancy lists several educational and professional pathways. Candidates should check the official application page to determine which pathway applies to their qualifications and experience.
Educational Qualifications
The listed qualifications include:
- Any graduate degree, subject to the applicable eligibility pathway.
- BHMS – Bachelor of Homoeopathic Medicine and Surgery.
- BAMS – Bachelor of Ayurvedic Medicine and Surgery.
- BUMS – Bachelor of Unani Medicine and Surgery.
- BPT – Bachelor of Physiotherapy.
- MPT – Master of Physiotherapy.
- B.Sc Nursing.
- BDS – Bachelor of Dental Surgery.
The listing identifies BHMS, BAMS, BUMS, BPT, and MPT among preferred medical or healthcare qualifications. It specifically mentions B.Sc Nursing and BDS candidates with one year of corporate experience.
Medical Coding Certification and Experience
For the non-medical-graduate pathway, the vacancy specifies:
- More than one year of experience in relevant specialty coding, such as evaluation and management (E&M), surgery, or anesthesia.
- A certified coder credential through AAPC.
- CPC certification only, as specified in the listing.
The description states that experience limited to HCC coding alone does not meet the specified specialty-coding experience requirement.
Required Skills
Applicants should demonstrate:
- Strong attention to detail.
- A quality-focused working approach.
- Good analytical and comprehension skills.
- Knowledge of medical records and relevant coding concepts.
- Ability to work independently.
- Understanding of claims review and compliance requirements, where applicable.
Preferred Experience and Knowledge
Optum identifies the following as preferred:
- Claims processing experience.
- Knowledge of health insurance.
- Familiarity with managed care.
- Understanding of the US healthcare system and medical coding.
- Experience working with medical records.
These skills may be useful for candidates handling claims investigations involving medical documentation and payment decisions.
Job Location and Travel
The position is based in Noida, Uttar Pradesh, India. The vacancy states that travel is not required.
The supplied description does not confirm whether the position is office-based, hybrid, or remote. Candidates should check the official careers listing for the applicable work arrangement.
Salary and Benefits
The salary for the Clinical Investigator position has not been disclosed in the supplied vacancy details.
Optum describes a work environment that emphasizes inclusion, professional development, and employee benefits. The exact compensation and benefits applicable to this position should be confirmed through the official recruitment process.
How to Apply for Optum Clinical Investigator Recruitment 2026
Interested candidates can review the job details and submit their applications through the UnitedHealth Group careers portal.
Before applying, prepare an updated resume highlighting your healthcare qualification, relevant coding certification, specialty-coding experience, claims processing knowledge, and medical record review skills.
Candidates should carefully verify the qualification pathway and experience requirements that apply to their profile.
Frequently Asked Questions (FAQs)
1. Which company is hiring for Clinical Investigator?
Optum, part of UnitedHealth Group, is recruiting for the Clinical Investigator position.
2. Where is the job located?
The position is based in Noida, Uttar Pradesh, India.
3. What is the requisition number?
The requisition number is 2389227.
4. What qualifications are accepted?
The listing includes several healthcare qualifications, such as BHMS, BAMS, BUMS, BPT, MPT, B.Sc Nursing, and BDS, along with other graduate and coding-certification pathways subject to the stated criteria.
5. Is medical coding certification required?
The listing specifies AAPC certification with CPC as the accepted certification for the relevant non-medical-graduate pathway.
6. How much experience is required?
The listing specifies more than one year of relevant specialty-coding experience for the non-medical-graduate pathway. B.Sc Nursing and BDS candidates are also specifically required to have one year of corporate experience.
7. Can candidates with only HCC coding experience apply?
The supplied description states that the specified specialty-coding experience should include areas such as E&M, surgery, or anesthesia, and not HCC coding alone. Candidates should confirm their eligibility against the official criteria.
8. Is travel required?
No. The job listing states that travel is not required.
9. What is the salary for this position?
The salary has not been disclosed in the supplied vacancy details.
10. How can candidates apply?
Candidates can apply through the official UnitedHealth Group careers link provided above.
Disclaimer
This article is a rewritten summary of the supplied Optum / UnitedHealth Group vacancy information. Eligibility requirements, job availability, compensation, and work arrangements may change. Candidates should verify the latest details on the official careers page before applying.