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Remote Insurance Utilization Review Jobs in Arkansas

Tooth and Coin

Staff Tax Accountant

Little Rock, AR · On-site +1

$60K - $80K/yr

About Tooth & Coin Tooth & Coin is a fully remote, digital CPA firm specializing in serving dental ... Short-term and long-term disability insurance paid * Up to 4% 401(k) match * Unlimited PTO

JDA

Sr. Director, Finance -IT

Bentonville, AR · On-site +1

US Remote Dallas and Scottsdale preferred Overview: The Senior Director, Finance IT is a senior ... Conduct regular license and entitlement reviews across all Finance platforms to ensure the ...

Tooth and Coin

Staff Tax Accountant

Little Rock, AR · On-site +1

$60K - $80K/yr

About Tooth & Coin Tooth & Coin is a fully remote, digital CPA firm specializing in serving dental ... Short-term and long-term disability insurance paid * Up to 4% 401(k) match * Unlimited PTO

Veristat

Principal Medical Writer

England, AR · On-site +1

... include: o Remote working o Flexible time off o Paid holidays o Medical insurance o Tuition ... Automated Decision Making: All applicants are reviewed by a member of the Veristat Talent ...

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Remote Insurance Utilization Review 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.

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 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.

What are popular job titles related to Remote Insurance Utilization Review jobs in Arkansas?

For Remote Insurance Utilization Review jobs in Arkansas, the most frequently searched job titles are:

What job categories do people searching Remote Insurance Utilization Review jobs in Arkansas look for?

The top searched job categories for Remote Insurance Utilization Review jobs in Arkansas are:

Remote Insurance Utilization Review jobs near you

Liability Claims Examiner - Remote - Little Rock, Arkansas, United States

Davies

Little Rock, AR • On-site, Remote

Full-time

Re-posted 9 days ago

Job description

Company:
ClaimsPro LP - International Programs Group
Liability Claims Examiner - Remote - Little Rock, Arkansas, United States
IPG works in the contiguous 48 states, Hawaii, and Puerto Rico handling a variety of claims including, but not limited to auto physical damage, inland marine cargo, dealers' open lot, property damage (commercial and homeowners) and general liability
Reporting to a Claims Supervisor, the Claims Examiner is responsible for investigating and settling liability and first party claims and third-party claims, with an emphasis on strong communication and customer service, while utilizing state specific guidelines..
Job Responsibilities:
  • Initiate the investigation of new claims
  • Make liability/coverage decisions
  • Evaluate and negotiate settlements of collision, specified perils, property damage, and liability losses as appropriate.
  • Manage and oversee the work of outside adjusters, appraisers and experts.
  • Establish contact with the insured and claimant within established protocol.
  • Recognize coverage issues and bring them to the attention of the supervisor.
  • Develop basic understanding of liability and coverage principles.
  • Recognize state specific laws and claims regulations throughout the United States to insure proper compliance in claims investigation including sending and securing proper documentation.
  • Complete research to determine market value on automobiles and heavy equipment to make recommendations on total loss settlement values using proper state valuation methods.
  • Summarize and make recommendations for disposition of claims in excess of the individual settlement authority.
  • Respond to time sensitive material including but not limited to intercompany arbitration hearings, and department of insurance complaints.
  • Manage a diary system to systematically review and resolve claims within the specified state compliance guidelines.
  • Maintain state license by completing continuing education coursework and/or work towards a claims designation.
  • Handle small claim suits as needed.
  • Other duties as assigned by the claims supervisor
  • Duties may be added, deleted or changed at any time at the discretion of management, formally or informally, either verbally or in writing.

Qualifications: Education and/or Experience
  • 2-5 years experience with any of these areas - auto physical damage, inland marine cargo, dealers' open lot, property damage (commercial and homeowners) and general liability
  • High School Diploma or Equivalent required
  • Bachelor's degree is preferred
  • Experience with Lloyd's of London is preferred

Computer Skills
  • Proficient in Microsoft Office
  • Experience with Xactimate

Certificates, Licenses, Registrations
  • Able to be licensed in states, countries where necessary
  • AIC designation preferred

Competencies
  • Use of clear, rational, thinking supported by evidence to audit fees of independent adjusters, appraisers, and other vendors in order to properly manage and pay expense invoices.
  • Strong writing skills and proper use of grammar to prepare written status reports for the principal. Document claim file notes clearly with all communications and activities that occur during of handling the claim using factual and objective information.
  • Ability to plan and exercise conscious control over the amount of time spent on specific activities.
  • Strong Communicator (verbal and written)
  • Ability to multi-task and handle high volume of concurrent tasks
  • Work collaboratively with others inside and outside the company

Environment/Working Conditions:
  • Dynamic environment with tight deadlines, number and changing priorities
  • All prospective employees must pass a background check
  • Office environment including prolonged periods of computer use
  • Only US citizens will be considered
  • Location: Remote working but may require some travel to home office, etc.

We welcome and encourage applications from people with disabilities. Accommodation is available on request for candidates throughout the recruitment and assessment process.
Unsolicited Outreach Statement - Recruitment Agencies
We will not accept unsolicited resume submittals from third- party recruiters and hereby request agencies not to contact our employees or managers directly to present candidates. Be advised we will NOT pay a fee for any placement resulting from the receipt of an unsolicited resume and will consider any unsolicited resumes forwarded public information. We welcome resumes submitted directly from candidates.
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