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Insurance Utilization Reviewer Jobs in Raleigh, NC

Qualus

Lead Engineer - Distribution

Raleigh, NC · On-site +1

$99K - $131K/yr

Coordinate task assignments to maximize staff utilization. * Review of completed designs and design ... Life Insurance, Short and Long-Term Disability, 401(k) match, Flexible Spending Accounts, EAP ...

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Showing results 21-40

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 Aug 22, 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 is an insurance utilization reviewer?

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 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 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 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 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.

Department Manager-Water/Wastewater

Colliers Engineering & Design

Cary, NC • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 27 days ago

Colliers Engineering & Design rating

7.7

Company rating: 7.7 out of 10

Based on 11 frontline employees who took The Breakroom Quiz

266th of 449 rated engineering

Job description

Overview
Colliers Engineering & Design is seeking a Department Manager to join our Water/Wastewater team in Raleigh, NC! We are seeking a seasoned and dynamic leader who can help us build our Water/Wastewater business in this region.
At Colliers Engineering & Design, we're not just shaping the community, we're shaping the future. As a national, multi-disciplinary engineering and design powerhouse, we bring cutting-edge solutions to complex challenges across the public sector! Our culture thrives on innovation, collaboration, and the drive to deliver excellence. This is your chance to join a passionate team that's shaping the communities of tomorrow.
Responsibilities
  • Provide leadership, strategic/managerial direction, and guidance to achieve established financial and growth goals for the discipline.
  • Responsible for overall productivity, profitability, client satisfaction, and quality of work.
  • Develop, execute, and lead discipline marketing and business development strategies in collaboration with the marketing and business development teams.
  • Work with leadership to build a production team.
  • Evaluate and monitor budgets, billing, and collections.
  • Consistently monitors the backlog of work and the sharing of resources within the discipline, maximizing staff utilization. Reviews staff utilization regularly and promptly addresses staff not meeting utilization goals.
  • Responsible for fostering staff professional development, monitoring staffing/recruiting activity, and effectively managing employee relations.
  • Comply with and ensure others' compliance with all policies and procedures.
  • Serve as project manager while being a resource for staff on assigned projects and manage completion of projects regarding scope, schedule, quality, and budget.
  • Provide staff with technical assistance and supervision in the preparation of proposals and contracts for assigned projects.
  • Prepare pertinent information for client/agency meetings and attend, as needed.
  • Develop the skills and abilities of staff which are necessary for successful execution of work duties.
  • Serve as a mentor and coach staff.
  • Manage the performance of assigned staff, conduct performance evaluations, and provide input for promotions and staff advancement.
  • Collaborate with other firms in pursuit of opportunities and manage subconsultant contracts.

Qualifications
  • Bachelor's degree in civil engineering.
  • P.E. (Professional Engineer) license required.
  • 8+ years of experience in civil/environmental engineering with concentration on water/wastewater design.
  • Ability to read, write, and understand English for purposes of comprehending written job-related communications and verbal instructions and interactions.
  • Ability to manage clients and develop new business.
  • Excellent communication skills.

What We Offer
At Colliers Engineering & Design, our people are our most important resource. That's why we are committed to providing all our employees with a safe, comfortable work environment, potential for career advancement, and the ability to impact society through their projects as well as Company sponsored activities.
This dedication begins with supporting a work life balance through a generous compensation package that includes: company paid medical, dental, and vision coverage; paid pregnancy disability leave; short- and long-term disability insurance; life insurance; a company-matched 401(k)/Roth; paid time off that includes parental and military leave; employee referral and professional license bonuses and a straight time policy that compensates exempt employees for billable hours worked in excess of 40 billable hours within a work week.
We have also created an internal culture that provides the resources and technology needed to encourage personal and professional growth opportunities through reimbursement for education; a free in-house resource for hundreds of educational and self-enrichment courses; mentorship program; wellness program; Women's Organization and ongoing philanthropic opportunities.
Apply today to learn how you can join our team of professionals, so we can help you Accelerate Your Success!

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About Colliers Engineering & Design

Sourced by ZipRecruiter

Colliers Engineering & Design, an affiliate of Colliers, is a trusted provider of multi-discipline engineering and architecture, design and consulting services to public and private sector clients. Headquartered in Holmdel, New Jersey with offices throughout the United States, we specialize in providing a comprehensive suite of services including civil/site, architecture, transportation, survey/geospatial, infrastructure, governmental, geotechnical/environmental, telecommunications, utilities/energy and project management. We employ professionals who utilize the most advanced technologies to deliver customized solutions for our clients.

Industry

Engineering professional services

Company size

1,001 - 5,000 Employees

Headquarters location

Holmdel, NJ, US

Year founded

1984

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