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Remote Insurance Utilization Review Jobs in Indiana

Cobol/IDMS Developer (Remote)

Indianapolis, IN · On-site +1

$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 ...

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 ...

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 ...

Our mission is to reinvent commercial insurance in the mobility space to offer our partners ... Reviews existing work processes to prioritize and execute internal department improvements. * Makes ...

... 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 ...

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 ...

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Showing results 1-20

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 cities in Indiana are hiring for Remote Insurance Utilization Review jobs? Cities in Indiana with the most Remote Insurance Utilization Review job openings:
Commercial Auto/GL Claims Specialist

Commercial Auto/GL Claims Specialist

Amerisure Mutual Insurance Company

Indianapolis, IN • Remote

Full-time

Medical, Retirement, PTO

Posted 10 days ago


Job description

Amerisure creates exceptional value for its partners, policyholders, and employees. As a property and casualty insurance company, Amerisure's promise to our partner agencies and policyholders begins with a comprehensive line of insurance products designed to protect businesses, as well as the health and safety of every employee. With an A.M. Best "A" (Excellent) rating, Amerisure serves mid-sized commercial enterprises focused in construction, manufacturing and healthcare. Ranked as one of the top 100 Property & Casualty companies in the United States, we proudly manage nearly $1 Billion of Direct Written Premium and maintain $1.21 billion in surplus.

Amerisure is currently recruiting for a Commercial GL & Auto Claims Specialist with experience with handling claims that deal with risk transfer, subcontractors, and general contractors. This role can have a Hybrid or Remote work arrangement. Candidates who live near one of our office locations will have the expectation of working in an office 3 days a week (Tuesday through Thursday). Candidates who do not live near an office will have a remote work arrangement, with the expectation of coming into an office as business needs arise. The ideal candidate will also possess the following skill set.

Summary Statement

Provides quality investigation and analysis to adjust claims of high complexity/severity, including litigated files, to proper resolution. Promotes the success of the organization through development of relationships with agencies, policyholders and employees. Serves as a relationship contact for assigned agent(s) related to all claims.

Essential Tasks/Major Duties

  • Collaborate proactively with agents, policyholders and internal stakeholders on claims of high complexity/severity and provide strategic input on book of business.
  • Investigate losses, identify coverage, evaluate liability and damages, review and analyze documents and legal pleadings independently.
  • Collaborate with counsel to manage litigated claims and leverage past experience to analyze documents and legal pleadings.
  • Develop plan of action to proactively conclude claims, timely evaluate damages, engage other parties in negotiations and settle claims pursuant to guidelines.
  • Establish and maintain proper reserves for each claim to accurately reflect the financial exposure.
  • Determine need for, identify and engage external resources as needed to execute proper resolutions while monitoring and controlling costs.
  • Address contractual indemnifications and/or additional insured coverage issues.
  • Review and interpret commercial insurance policies and accordingly communicate coverage issues verbally and in writing.
  • Participate on cross functional teams to identify and resolve issues and design and implement solutions to prevent future occurrence as necessary.

Knowledge, Skills & Abilities

  • Bachelor's degree or equivalent combination of education and experience.
  • 6 years of experience handling general liability and/or bodily injury claims of high level of complexity/severity.
  • Experience with contractual indemnification and additional insured coverages.
  • AIC or SCLA certification preferred.
  • Ability to obtain appropriate state licensing as required.
  • Proficient computer skills required including Microsoft Office Suite.
  • Demonstrated successful ability to build positive relationships and partnerships within department, across the organization and with external customers.
  • Strong analytical skills and attention to detail.
  • Excellent verbal and written communication skills with the ability to interact with internal and external customers.
  • Ability to travel overnight up to 10%
  • Ability to travel daily between locations.

#LI-Remote

Just as we are committed to creating exceptional value for our Partners For Success agencies and policyholders, Amerisure also remains committed to being an employer of choice. We reinforce this commitment by adhering to an Employee Value Proposition that, in part, is provided through a competitive total rewards package. This package includes competitive base pay, performance-based incentive pay, comprehensive health and welfare benefits, a 401(k) savings plan with profit sharing, and generous paid time off programs. We also offer flexible work arrangements to promote work-life balance. Recognized as one of the Best and Brightest Companies to Work For in the Nation and one of Business Insurance magazine's Best Places to Work in Insurance, we provide a workplace that fosters excellence and professional growth. If you are looking for a collaborative and rewarding career, Amerisure is looking for you.

Amerisure Mutual Insurance Company is an Equal Employment Opportunity employer. Amerisure provides equal employment opportunities to all employees and applicants without regard to race, color, religion, sex (to include sexual orientation and gender identity), national origin, age, disability, genetic information, veteran status, or any other protected characteristic under applicable federal, state, or local laws. Amerisure complies with all applicable laws governing nondiscrimination in employment in all locations where the company operates. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. Amerisure prohibits harassment or discrimination of any kind and is committed to maintaining a workplace free from unlawful harassment or discrimination. Amerisure prohibits retaliation against anyone who reports discrimination, participates in an investigation, or opposes unlawful practices. Any improper interference with an employee's ability to perform their job duties may result in disciplinary action, up to and including termination.