Utilization Management Specialist

Job Summary

A company is looking for a Utilization Management Specialist who will be responsible for reviewing appeals and managing documentation related to medical decisions.

Key Responsibilities

• Research and manage incoming department correspondence and ensure proper documentation is completed
• Ensure compliance with State and Federal regulations as well as organizational mandates related to claims processing
• Collaborate with the Appeals Specialist team to manage daily tasks and confirm member eligibility prior to medical review

Required Qualifications

• High School Diploma or equivalent
• Experience in a health care field and/or insurance auditing
• Familiarity with medical terminology
• Ability to work rotating weekend/holiday shifts as needed
• Two years of customer service experience with an understanding of various lines of business (preferred)