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Remote Insurance Utilization Review Jobs in Alabama

This position is fully remote. Overview The Healthcare Data Analyst Senior provides data analysis ... Experience in Epic, claims, quality,utilization, finance, operations, service lines, population ...

... Insurance Group (CSAA IG), a AAA insurer, is one of the leading personal lines property and ... Write and review repair estimates, evaluate contractor estimates, and determine appropriate claim ...

New

Run quarterly business reviews with practice leadership using their own metrics: answer rates, hold ... Channel structured client feedback to product Location Remote (US) with approximately 25% travel to ...

Our mission is to reinvent commercial insurance in the mobility space to offer our partners ... Review work of Consultants and Analysts and oversees the successful completion of projects within ...

Run quarterly business reviews with practice leadership using their own metrics: answer rates, hold ... Channel structured client feedback to product Location Remote (US) with approximately 25% travel to ...

Review work of peers and provide training to junior analysts * Develops and analyzes data related ... Develops and analyzes new methodologies for insurance rating and loss reserving Required Experience ...

$64K - $83K/yr

Our mission is to reinvent commercial insurance in the mobility space to offer our partners ... Work from a diary system to review and resolve claims within state compliance guidelines, policy ...

If remote from Atlanta or anywhere else, monthly travel to Calvert, Alabama for 2-3 day stay ... Draft, review, and negotiate a wide range of procurement and buy-side agreements, including ...

Conduct regular check-in calls with value-based messaging, along with Quarterly Business Reviews to ... Medical/Dental/ Vision, STD/LTD, Life Insurance * Flexible PTO and Company-paid holidays * Remote ...

Conduct regular check-in calls with value-based messaging, along with Quarterly Business Reviews to ... Medical/Dental/ Vision, STD/LTD, Life Insurance * Flexible PTO and Company-paid holidays * Remote ...

Conduct regular check-in calls with value-based messaging, along with Quarterly Business Reviews to ... Medical/Dental/ Vision, STD/LTD, Life Insurance * Flexible PTO and Company-paid holidays * Remote ...

Showing results 21-40

Remote Insurance Utilization Review information

What is the difference between Remote Insurance Utilization Review vs Remote Claims Reviewer?

AspectRemote Insurance Utilization ReviewRemote Claims Reviewer
CredentialsTypically requires nursing or healthcare-related certifications, such as RN or licensed healthcare professionalUsually requires insurance or claims processing knowledge, sometimes with certifications like CPC or CPC-H
Work EnvironmentRemote, healthcare or insurance company settings, reviewing medical necessity and appropriateness of servicesRemote, insurance companies or third-party administrators, reviewing claims for accuracy and compliance
Industry UsageCommonly used in healthcare insurance to evaluate medical necessityUsed across insurance sectors to process and validate claims

Remote Insurance Utilization Review focuses on assessing the medical necessity of services, often requiring healthcare credentials. Remote Claims Reviewers handle claims processing and validation, emphasizing insurance knowledge. Both roles are remote and industry-specific but differ in their primary responsibilities and required qualifications.

How does a remote insurance utilization review professional collaborate with healthcare providers and insurance companies?

Remote insurance utilization review professionals regularly interact with healthcare providers to gather patient information, clarify treatment plans, and ensure that clinical documentation supports insurance requirements. They also communicate with insurance companies to advocate for patient care, provide necessary justifications, and resolve coverage issues. While the work is done remotely, collaboration typically occurs via secure email, phone calls, and virtual meetings, requiring strong communication and organizational skills to ensure timely and accurate exchange of information.

What is a remote insurance utilization review?

Remote insurance utilization review jobs involve evaluating medical records and treatment plans to determine whether healthcare services are medically necessary and covered by a patient’s insurance plan. Professionals in these roles, often nurses or other healthcare specialists, work from home and communicate with healthcare providers, insurance companies, and patients. Their main goal is to ensure that patients receive appropriate care while also helping insurance companies manage costs and comply with regulations.

What skills and qualifications are needed for a remote insurance utilization review specialist?

To thrive as a Remote Insurance Utilization Review Specialist, you need a strong understanding of medical terminology, clinical guidelines, and insurance policies—usually supported by a nursing or health-related degree and relevant licensure. Familiarity with electronic medical record (EMR) systems, insurance claims platforms, and utilization review software is essential. Strong analytical skills, attention to detail, and effective written communication are crucial soft skills for this role. These competencies ensure accurate case evaluations, compliance with regulations, and clear communication between healthcare providers and insurers.
What are the most commonly searched types of Insurance Utilization Review jobs in Alabama? The most popular types of Insurance Utilization Review jobs in Alabama are:
What cities in Alabama are hiring for Remote Insurance Utilization Review jobs? Cities in Alabama with the most Remote Insurance Utilization Review job openings:

Senior Healthcare Data Analyst

Sentara

Centre, AL • Remote

$80K - $133K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.


Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 398 frontline employees who took The Breakroom Quiz

492nd of 887 rated healthcare providers


Job description

City/State

Virginia Beach, VA

Work Shift

First (Days)

Overview:

Sentara is hiring a Senior Healthcare Data Analyst!

This position is fully remote.

Overview

The Healthcare Data Analyst Senior provides data analysis support to the customer by assisting with the development of reports and/or dashboards to monitor program and operational performance. Promotes self-service analytics for customer adoption, understanding and use of data. Supports design of programmatic analyses and reporting capabilities in addition to business requirement definition for new analyses and performs ad-hoc analysis as directed. This position supports data quality and data stewardship functions to maintain data accuracy and identify new metrics. As a subject matter expert, the Healthcare Data Analyst Senior uses analytic skills to offer data-driven conclusions and recommendations to business partners.

Education
  • Bachelor's Degree in analytics, statistics, informatics, business, public health, or related field (Required)
Certification/Licensure
  • Epic certification in either Clarity, Caboodle or Cogito (Required)
Experience
  • 3 years of experience in data analysis (Required)
  • Must have advanced-level skills in Microsoft Excel, SQL, Power BI, data validation, dashboard development, databricks
  • Must have hands-on analysis, dashboard delivery, recurring and ad hoc reporting, metric development
  • Experience in Epic, claims, quality,utilization, finance, operations, service lines, population health is preferred
  • Looking for someone who can independently build dashboards, answer business questions, and explain insights clearly to partners
  • Looking for someone with experience solving business problems with data
  • Ability to communicate findings clearly with operational, clinical, finance, or executive stakeholders.

Talroo

Keywords: healthcare analytics, SQL, Power BI, dashboard development, data visualization, stakeholder consulting, requirements gathering, data quality, governance, Epic, claims, clinical data, utilization, cost and outcomes, quality metrics, population health, Databricks, Azure, ETL, data warehouse.

We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for full-time employment is $80,204.80 - $133,681.60. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Benefits: Caring For Your Family and Your Career
Medical, Dental, Vision plans
Adoption, Fertility and Surrogacy Reimbursement up to $10,000
Paid Time Off and Sick Leave
Paid Parental & Family Caregiver Leave
Emergency Backup Care
Long-Term, Short-Term Disability, and Critical Illness plans
Life Insurance
401k/403B with Employer Match
Tuition Assistance - $5,250/year and discounted educational opportunities through Guild Education
Student Debt Pay Down - $10,000
Reimbursement for certifications and free access to complete CEUs and professional development
Pet Insurance
Legal Resources Plan
Colleagues have the opportunity to earn an annual discretionary bonus ifestablished system and employee eligibility criteria is met.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.


In support of our mission "to improve health every day," this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.


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