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Remote Insurance Utilization Review Jobs in Indiana

A.C. Coy

Cobol/IDMS Developer (Remote)

Indianapolis, IN · Remote

$48 - $65/hr

... and utilization of electronic data processing systems for product and commercial software ... Review project requests describing database user needs to estimate time and cost required to ...

A.C. Coy

Cobol/IDMS Developer (Remote)

Indianapolis, IN · Remote

$48 - $65/hr

... and utilization of electronic data processing systems for product and commercial software ... Review project requests describing database user needs to estimate time and cost required to ...

Spieldenner Financial Group

Remote Sales

Fort Wayne, IN · On-site +1

$10K - $20K/wk

... review their needs. Prepare Personalized Solutions (4-5 hrs/week) Analyze client information to ... Manage Follow-Up (2 hrs/week) Coordinate with insurance carriers and support clients through the ...

CSAA

... Insurance Group (CSAA IG), a AAA insurer, is one of the leading personal lines property and ... Review and process purchase requisitions and change orders * Execute sourcing activities, primarily ...

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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 are remote insurance utilization review jobs?

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 are the key skills and qualifications needed to thrive as a Remote Insurance Utilization Review Specialist, and why are they important?

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 popular job titles related to Remote Insurance Utilization Review jobs in Indiana? For Remote Insurance Utilization Review jobs in Indiana, the most frequently searched job titles are:
What job categories do people searching Remote Insurance Utilization Review jobs in Indiana look for? The top searched job categories for Remote Insurance Utilization Review jobs in Indiana are:
What cities in Indiana are hiring for Remote Insurance Utilization Review jobs? Cities in Indiana with the most Remote Insurance Utilization Review job openings:
Remote Insurance Utilization Review jobs near you
Cobol/IDMS Developer (Remote)

Cobol/IDMS Developer (Remote)

A.C. Coy

Indianapolis, IN • Remote

$48 - $65/hr

Contractor

Posted 21 days ago

Job description

  • Tier One Technologies is looking for a COBOL/IDMS Developer to maintain and support a large payroll application as well as helping in the database environment.
  • This will be a 100% remote Contract-to-Hire position.
  • Must be a US Citizen.
  • SELECTED CANDIDATES WITHOUT REQUIRED CLEARANCE WILL BE SUBJECT TO A FEDERAL GOVERNMENT BACKGROUND INVESTIGATION TO RECEIVE IT.

  • Design, develop and modify software systems, using scientific analysis and mathematical models to predict and measure outcomes and consequences of design.
  • Coordinate software system installations and monitor equipment functioning to ensure specifications are met.
  • Modify existing databases and database management systems.
  • Write and code logical and physical database descriptions and specify identifiers of database to management system or direct others in coding descriptions.
  • Work as part of a project team to coordinate database development and determine project scope and limitations.
  • Conduct multidisciplinary research and collaborate with equipment designers and/or hardware engineers in the planning, design, development, and utilization of electronic data processing systems for product and commercial software.
  • Determine computer user needs; analyze system capabilities to resolve problems on program intent, output requirements, input data acquisition, programming techniques and controls; prepare operating instructions; design and develop compilers and assemblers, utility programs, and operating systems.
  • Ensure software standards are met. Analyze user needs and software requirements to determine feasibility of design within time and cost constraints.
  • Confer with systems analysts, engineers, programmers and others to design systems and to obtain information on project limitations and capabilities, performance requirements and interfaces.
  • Review project requests describing database user needs to estimate time and cost required to accomplish project.

  • Bachelor’s degree in Computer Science, Software Engineering, or a related field required.
  • 8+ years of IBM z/OS-based mainframe experience using COBOL, JCL, TSO, ISPF, Endevor, and REXX.
  • Expertise working with the CA IDMS system, with the ability to perform the following:
    • CA IDMS database installation & maintenance
    • CA IDMS buffer tuning
    • CA IDMS index tuning
    • CA IDMS system generation
    • CA IDMS security administration
  • Must have active CompTIA Security+ certification.
  • Ability of designing, coding and testing software requirements.
  • Familiarity with computer development software as it relates to systems, such as SQL, Visual Basic, etc.
  • Basic knowledge of the full software development lifecycle: from business/systems analysis, through requirements gathering and functional specification authoring, to development, testing and delivery.
  • Familiarity and knowledge of the Agile methodology is a plus.
  • Strong verbal and written communication skills, problem solving skills, customer service and interpersonal skills.
  • Must be a US Citizen and be able to obtain a DoD Public Trust clearance.
  • Must not have traveled outside the US for a combined total of 6 months or more in the last 5 years.
  • Must have resided in the US for the last 5 years.
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About A.C. Coy Company- Staffing & Consulting Services

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Since 1986, our mission is to be the “Always on Target” staffing and consulting provider by helping people and companies achieve their hiring goals. The team is dedicated to achieving these goals by attracting and retaining top talent that meets our clients’ culture and environment. We are fully engaged with our people and companies through ongoing communication to ensure expectations are met.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Canonsburg, PA, US

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