Healthcare Utilization Review Specialist

This is a fully remote position, open to applicants in Texas.

📋 Description

• Become a part of our team at Company and embark on a rewarding career in employee benefits solutions.

• Assess claims within utilization review queues to determine medical necessity and authorization status.

• Assist in the daily operations of the Utilization Review department by supporting senior UR team members.

• Conduct outreach calls and gather data following established scripts, tools, and protocols.

• Handle correspondence and faxes in line with timeliness standards.

• Carry out clerical and administrative tasks, including scanning, document retrieval, and urgent claims processing support.

• Communicate effectively, professionally, and courteously with both internal and external stakeholders.

• Provide written guidance to other team members to ensure accurate claims processing.

• Stay updated on Standard Operating Procedures and member benefits.

• Ensure adherence to BCBS Association standards and company policies.

• Perform other related tasks and projects as assigned.

⛳️ Requirements

• Training or certification as a medical assistant, home health aide, nursing assistant, or other similar healthcare para-professional.

• Proficient computer skills, including MS Office (Word, Excel, and Outlook) and Internet applications.

• Strong reading comprehension abilities.

• Self-motivated and self-directed, capable of working without constant supervision.

• Ability to make sound logical decisions and clearly articulate the reasoning behind them.

🏝️ Benefits

• Excellent medical, dental, and vision insurance*

• Biannual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible!

• Company-provided Basic Life and AD&D insurance.

• Company-paid Short-Term and Long-Term Disability**

• Flexible Spending Accounts*

• 401(k) Retirement Plan with up to a 6% employer match**

• WOW! (100% fully vested after 3 years)

• Over 10 paid holidays

• Generous paid vacation and sick leave

• Annual Volunteer Paid Day

• Annual Tuition Reimbursement

• Annual Health and Wellness Reimbursement

• Numerous enjoyable company events