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Insurance Utilization Review Jobs in Rochester, NY

Responsible for Utilization Record Review functions to include Individual record audits, admission ... Medical Insurance, Dental Insurance, Vision Insurance, Life Insurance, Generous PTO & Paid Holidays ...

Responsible for Utilization Record Review functions to include Individual record audits, admission ... Medical Insurance, Dental Insurance, Vision Insurance, Life Insurance, Generous PTO & Paid Holidays ...

Complete government Purchase Order compliance reviews to support maintaining an approved purchasing ... Evaluate Request for Proposal (RFP) requirements for Small Business utilization and participation.

Oversee the review of binders and policies to ensure terms and conditions are accurately reflected ... utilization * Develop and maintain thorough knowledge of insurance marketplace, products and ...

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How much do insurance utilization review jobs pay per hour?

As of Jun 11, 2026, the average hourly pay for insurance utilization review in Rochester, NY is $41.72, according to ZipRecruiter salary data. Most workers in this role earn between $32.98 and $47.93 per hour, depending on experience, location, and employer.

What are the most common challenges faced by Insurance Utilization Review professionals?

One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.

What are the key skills and qualifications needed to thrive in the Insurance Utilization Review position, and why are they important?

To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What is an Insurance Utilization Review job?

An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.

What are the most commonly searched types of Insurance Utilization Review jobs in Rochester, NY? The most popular types of Insurance Utilization Review jobs in Rochester, NY are:
What job categories do people searching Insurance Utilization Review jobs in Rochester, NY look for? The top searched job categories for Insurance Utilization Review jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Insurance Utilization Review jobs? Cities near Rochester, NY with the most Insurance Utilization Review job openings:
Billing Specialist - Shared Services

Billing Specialist - Shared Services

Insurance Office of America

Newark, NY • On-site

$40K - $60K/yr

Full-time

Medical, Retirement

Posted 15 days ago


Insurance Office Of America rating

8.6

Company rating: 8.6 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

73rd of 260 rated insurance


Job description

Description

Job Description:

Title: Billing Specialist – Shared Services 

Remote: candidates in Easter, Central or Mountain Time Zones | Supporting: Shared Services
Seeking: 2 years of billing and account support experience, EPIC experience preferred
Please note: If this position is posted as either fully remote and/or hybrid, in accordance with company policy, individuals residing within a 50-mile radius of a branch location may be required to work onsite in a hybrid capacity as there may be occasions when on-site presence is necessary to meet specific business needs. Additionally, our remote work policy includes having a dedicated, distraction-free workspace. Remote work is not a substitute for childcare, elder care, or other personal responsibilities during working hours. To view our branch locations, please visit: ioausa.com/locations 
 

About the Role: The Billing Specialist is responsible for processing Agency Bill transactions, including premiums, taxes, fees, installments, and related billing activities. This role ensures accurate and timely transaction entry within EPIC, supports internal teams with billing inquiries, and maintains high standards of data accuracy and operational efficiency. The Billing Specialist plays a critical role in supporting financial operations while delivering consistent, high‑quality results within established turnaround timelines. 

 
Key Responsibilities: 

  • Agency Bill Processing: Process Agency Bill transactions in EPIC, including premiums, taxes, fees, installments, split receivables, and wholesale billing. 

  • Transaction Execution: Generate and process transactions based on carrier invoices, rating sheets, allocation spreadsheets, and supporting documentation. 

  • Specialized Billing: Process pre‑bill transactions and surplus lines activity in accordance with business requirements and regulatory guidelines. 

  • Data Validation: Review and verify EPIC data fields, including policy numbers, commissions, ICO/PPE, and related billing details before processing. 

  • Billing Coordination: Collaborate with Account Management and internal teams to address billing questions, corrections, and discrepancies. 

  • Issue Resolution: Investigate and resolve billing issues, coordinating with appropriate departments and processing adjustments as needed. 

  • Documentation Management: Associate and manage documentation within EPIC activity codes to ensure accuracy and audit readiness. 

  • System Utilization: Navigate EPIC and utilize Microsoft Office tools (Outlook, Excel, Word) to support daily billing functions and communication. 

  • Turnaround & Quality Management: Deliver accurate work within established timelines while maintaining strong attention to detail and quality standards. 

  • Process Improvement: Identify opportunities to improve billing workflows, efficiency, and accuracy within agency billing processes. 

  • Champion IOA Values: Demonstrate integrity and leadership. 

Ideal Candidate Qualifications: 

  • Bachelor’s degree in Business, Accounting, Finance, or related field preferred; equivalent experience considered 

  • 2+ years of billing, accounting support, or customer service experience 

  • Experience with agency management systems (EPIC preferred) 

  • Strong attention to detail with the ability to manage high‑volume transactional work 

  • Proven analytical and problem‑solving skills 

  • Excellent verbal and written communication skills 

  • Proficiency in Microsoft Office applications, including Outlook, Excel, and Word 

  • Strong organizational, multitasking, and time‑management skills 

  • High level of personal integrity, accountability, and commitment to quality 

 
What We Offer: 

  • Competitive salaries and bonus potential 

  • Company-paid health insurance 

  • Paid holidays, vacations, and sick time 

  • 401K with employer match 

  • Professional growth and career progression opportunities 

  • Respectful culture and work/family life balance 

  • Community service commitment 

  • Supportive teammates and a rewarding work environment 

 
What to Expect (Application Process): 

  • 30-Minute Phone Screen, Online Assessments, and Interview(s) 

Salary Range

The expected pay range for this position is $40,000.00 - 60,000.00 annually, depending on experience, relevant skills, and geographic location.

Insurance Office of America is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.