Healthcare Utilization Specialist - Remote

Overview

Join our team at Company and build a meaningful career in employee benefits solutions. As a Healthcare Utilization Specialist, you’ll play a vital role in ensuring our clients and members receive the right care at the right time through customized, self-funded insurance programs.

In Short

• Review claims in utilization review queues for medical necessity and authorization status.
• Support daily operations of the Utilization Review department.
• Conduct outreach calls and collect data.
• Process correspondence and faxes in accordance with standards.
• Perform clerical and administrative tasks.
• Communicate clearly with stakeholders to resolve issues.
• Provide written direction to team members.
• Maintain knowledge of Standard Operating Procedures.
• Ensure compliance with standards and policies.
• Complete other related duties as assigned.

Requirements

• Prior training in coding, insurance, or medical vocabulary preferred.
• Fluent computer skills including MS Office.
• Strong reading comprehension.
• Self-motivated and operates without constant guidance.
• Ability to make sound logical decisions.

Benefits

• Comprehensive medical, dental, and vision insurance.
• Company paid Basic Life and AD&D.
• Company paid Short-Term and Long-Term Disability.
• Flexible Spending Accounts.
• 401(k) Retirement Plan with employer-match.
• 10+ paid holidays.
• Generous paid vacation and sick time.
• Fun company events.