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Insurance Utilization Reviewer Jobs in Raleigh, NC

Liberty Mutual Insurance

Premium Auditor II

Raleigh, NC · On-site

$61K/yr

... insurance guidelines and communicate audit findings through detailed formal reports. As a Premium ... Review appropriate audit documentation and/or company policy systems, to determine auditable ...

Red Oak Recovery Center

Clinical Director

Durham, NC · Remote

$90K - $100K/yr

Participate in utilization review meetings, representing patient needs in both clinical and ... Voluntary Coverages - Pet insurance, home and auto insurance, family legal services, and more.

Harris Teeter

Part Time Pharmacy Intern P1

Chapel Hill, NC · On-site

$14.25 - $17.75/hr

... Insurance Carrier or Pharmacy Benefit Manager, and expirationdates (if applicable), and patient ... Notify the pharmacist in the event of earlyfills or drug utilization review (DUR) messages. Ensure ...

Harris Teeter

Part Time Pharmacy Intern P2-#394

Durham, NC · On-site

$16.25 - $20/hr

... Insurance Carrier or Pharmacy Benefit Manager, and expirationdates (if applicable), and patient ... Notify the pharmacist in the event of earlyfills or drug utilization review (DUR) messages. Ensure ...

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All JobsInsurance Utilization Reviewer JobsInsurance Utilization Reviewer Jobs in Raleigh, NC

Insurance Utilization Reviewer information

See Raleigh, NC salary details

$30.1K

$36.9K

$42.8K

How much do insurance utilization reviewer jobs pay per year?

As of Jul 13, 2026, the average yearly pay for insurance utilization reviewer in Raleigh, NC is $36,932.00, according to ZipRecruiter salary data. Most workers in this role earn between $33,000.00 and $40,800.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as an Insurance Utilization Reviewer, and why are they important?

To thrive as an Insurance Utilization Reviewer, you need a solid understanding of medical terminology, healthcare regulations, and insurance processes, usually supported by a clinical background or relevant certification. Familiarity with utilization review software, electronic health records (EHRs), and coding systems like ICD-10 and CPT is often required. Strong analytical thinking, attention to detail, and effective communication skills help reviewers assess medical necessity and coordinate with healthcare providers. These skills ensure accurate, efficient case evaluations and compliance with policies, which are crucial for optimizing patient care and managing healthcare costs.

What is the difference between Insurance Utilization Reviewer vs Insurance Claims Processor?

AspectInsurance Utilization ReviewerInsurance Claims Processor
Primary RoleReview medical necessity and appropriateness of services for insurance coverageProcess and review insurance claims for payment and accuracy
Required CredentialsOften requires healthcare or insurance certifications, such as RHIT or CPCTypically requires claims processing or insurance certifications, like CPC or CPC-H
Work EnvironmentHealthcare settings, insurance companies, or third-party administratorsInsurance companies, healthcare providers, or claims processing centers
Industry UsageCommonly employed in health insurance and managed careWidely used across health, auto, and property insurance sectors

The main difference is that Insurance Utilization Reviewers focus on evaluating the medical necessity of services, while Insurance Claims Processors handle the administrative processing of claims. Both roles require insurance-related certifications and are integral to the insurance industry, but they serve distinct functions in the claims and coverage review process.

What are some common challenges faced by Insurance Utilization Reviewers, and how can they be addressed?

One of the primary challenges Insurance Utilization Reviewers face is balancing the need to adhere to strict insurance guidelines while advocating for appropriate patient care. Reviewers often handle high caseloads and must make timely decisions based on complex medical records, which requires strong attention to detail and up-to-date knowledge of coverage policies. Effective communication with healthcare providers and insurance representatives is also crucial to resolve discrepancies and ensure approvals. Staying organized, continuously updating clinical knowledge, and leveraging support from the utilization review team can help manage these challenges successfully.

What are Insurance Utilization Reviewers?

Insurance Utilization Reviewers are professionals who evaluate healthcare services to determine if they are medically necessary and covered by insurance policies. They review patient records, treatment plans, and insurance guidelines to ensure that the care provided aligns with established criteria and standards. Their work helps control healthcare costs, prevent unnecessary treatments, and ensure patients receive appropriate care. Utilization reviewers often communicate with healthcare providers and insurance companies to support or deny coverage decisions.
What are popular job titles related to Insurance Utilization Reviewer jobs in Raleigh, NC? For Insurance Utilization Reviewer jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Insurance Utilization Reviewer jobs in Raleigh, NC look for? The top searched job categories for Insurance Utilization Reviewer jobs in Raleigh, NC are:
Insurance Utilization Reviewer jobs near you
Infographic showing various Insurance Utilization Reviewer job openings in Raleigh, NC as of July 2026, with employment types broken down into 86% Full Time, and 14% Part Time. Highlights an 95% In-person, and 5% Remote job distribution, with an average salary of $36,932 per year, or $17.8 per hour.
Premium Auditor II

Premium Auditor II

Liberty Mutual Insurance

Raleigh, NC • On-site

$61K/yr

Full-time

Posted 17 days ago

Liberty Mutual rating

8.9

Company rating: 8.9 out of 10

Based on 144 frontline employees who took The Breakroom Quiz

33rd of 281 rated insurance

Job description

Description
Our professional auditors are integral to our company's mission by ensuring the financial integrity of premium development. In this role, you will examine policyholders' operations and financial records to ensure exposures (such as payroll, sales, fixed assets) are accurately calculated within strict insurance guidelines and communicate audit findings through detailed formal reports. As a Premium Auditor, you will work out of your home, when not traveling to policyholders' locations.
Responsibilities:
  • Perform examination of policyholders' accounting and financial records to ensure accurate calculation of earned premium for smaller, less complex risks.
  • Ensure that audited exposures (payroll, sales, fixed assets, etc.) are accurately calculated within strict insurance guidelines.
  • Communicate audit findings through detailed formal reports supported by audit workpapers.

Qualifications
  • Review appropriate audit documentation and/or company policy systems, to determine auditable exposures and coverages provided by the policy and plan audit strategy.
  • Investigate policyholder operations to obtain actual exposures, verify classifications as they apply to the policy and ensure conformity to various state laws and insurance regulations for the appropriate audit period.
  • Prepare detailed work papers and written correspondence in support of audit findings.
  • Identify issues to be communicated and socialize the audit information to appropriate stakeholders (i.e., Central Processing, Distribution, Underwriting, Agent/Broker, etc.) to elaborate on current risk conditions or initiate necessary changes to the policy contract. Exhibit effective workload management skills through efficient time utilization. This includes scheduling audit appointments taking into account priority and location of assignments within assigned territory managing work-in-process and documenting progress for appropriate stakeholders/management.
  • Perform routine administrative tasks such as: Time Tracking, Expense Reports, Mileage Reports, etc.
  • As assigned, coordinate assignment of multi-location audits for large risks review location audits to ensure quality and accuracy. Consolidate in proper format for rating purposes. As requested, assist with complex audits, Special Investigative Unit (SIU) related accounts, and/or special projects, including mentoring, presentations, etc.

About Us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: https://www.libertymutualgroup.com/about-lm/careers/benefits
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Fair Chance Notices
  • California
  • Los Angeles Incorporated
  • Los Angeles Unincorporated
  • Philadelphia
  • San Francisco

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About Liberty Mutual

Sourced by ZipRecruiter

Since 1912, we've grown into the fifth largest global property and casualty insurer based on 2022 gross written premium. We also rank 86 on the Fortune 100 list of largest corporations in the US based on 2022 revenue. ​At Liberty Mutual Insurance we work hard every day to support our customers and our people, so they can protect their families, build their businesses and invest in their futures. We are headquartered in Boston, but our people, our customers and our reach span the globe. So to better serve our global customers and employees, we are organized into three business units.

Industry

Insurance services

Company size

10,000+ Employees

Headquarters location

Boston, MA, US

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