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Remote Insurance Utilization Review Jobs in Nebraska

Cargill

Salesforce Senior Business Analyst

Blair, NE · On-site +1

The position is NOT open to remote work at this time. Key Accountabilities * PROJECT MANAGEMENT ... Conducts post implementation reviews to evaluate the effectiveness of deployed processes and ...

New

Great American Insurance Group

$110K - $120K/yr

Great American Insurance Group's member companies are subsidiaries of American Financial Group. We ... Occasional Travel- may require overnight travel to tri-annual claim reviews and/or departmental ...

First American

$26.88 - $35.82/hr

Review and analyze public records such as leases, subleases, deeds, liens, and easements to ... At least 3 years of directly related commercial title insurance experience in title searching ...

mchhs

CODING SPECIALIST, Full-time Days

Blair, NE · On-site +1

Enjoy the flexibility of a primarily remote role, with periodic onsite attendance for monthly ... Review and code inpatient, outpatient, emergency department, observation, surgical, and other ...

mchhs

CODING SPECIALIST, Full-time Days

Blair, NE · On-site +1

Enjoy the flexibility of a primarily remote role, with periodic onsite attendance for monthly ... Review and code inpatient, outpatient, emergency department, observation, surgical, and other ...

First American

$20.34 - $27.12/hr

An appropriate and thorough understanding of the requirements of title insurance including ... First American intends to conduct a review of an applicant's criminal history in connection with a ...

Wing Assistant

$40K - $50K/yr

Health Insurance * Flexible PTO plus holidays * Fully remote work * Company-wide virtual and/or in ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...

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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 Nebraska?

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

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

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

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Cities in Nebraska with the most Remote Insurance Utilization Review job openings:

Remote Insurance Utilization Review jobs near you

Salesforce Senior Business Analyst

Cargill

Blair, NE • On-site, Remote

Full-time

Posted yesterday

New

Cargill rating

7.4

Company rating: 7.4 out of 10

Based on 225 frontline employees who took The Breakroom Quiz

20th of 49 rated food wholesalers

Job description

Cargill is a family company committed to providing food and agricultural solutions to nourish the world in a safe, responsible, and sustainable way. We sit at the heart of the supply chain, partnering with producers and customers to source, make and deliver products that are vital for living. By providing customers with lifes essentials, we enable businesses to grow, communities to prosper, and consumers to live well.

This position is in our Food Enterprise where we are committed to serving food manufacturers, food service customers, and retailers with a complete range of innovative ingredients and branded products. Our portfolio includes poultry, beef, egg, alternative protein, salt, oils, starches, sweeteners, cocoa and chocolate.

Job Purpose and Impact

The Salesforce Business Analyst role serves as a critical team member for CORTX (salesforce-based platform) deployment projects within our Branded Feed Team working closely with our product owner(s), architect and development team using an agile environment to ensure alignment of business strategies, requirements and standards for a specific set of processes. As a member of the Branded Feed Team business the Salesforce Business Analysist will successfully translate business needs into actionable requirements, ensuring development meets acceptance criteria, assists with and manages UAT testing, and leads change management and training pre-deployment through implementation and hyper care of our technology-based products. This job partners to ensure that system configurations are consistently implemented and process changes are aligned with system capabilities and data structures.

This job is located in-office in Blair, Nebraska, and has in-office workday requirements. The position is NOT open to remote work at this time.

Key Accountabilities
  • PROJECT MANAGEMENT: Consolidates and confirms technology deployment objectives and scope from the assigned process perspective, leads monitoring project progress to identify deviations from plan, and recommends corrective actions to support successful deployment and implementation.
  • PROCESS DESIGN & GOVERNANCE: Collaborates with businesses, functions and subject matter authority to clarify and align all relevant business, process, data and control requirements with digital technology capabilities. Conducts fit gap analysis, evaluates process variations, and prepares key design decisions in compliance with governance.
  • UAT, TRAINING & CUTOVER: Validates that deployed solution meets process requirements during user acceptance testing, including data integrity, process compliance and scope of test scripts. Identifies subject matter authority to overcome obstacles, reports potential risks and dependencies, and develops end user training materials to ensure smooth adoption.
  • POST-GO-LIVE SUPPORT: Conducts post implementation reviews to evaluate the effectiveness of deployed processes and systems and analyze performance data to assess whether objectives have been met. Partners to recommend solutions to further improve process efficiency and system utilization.
  • CHANGE MANAGEMENT & ADOPTION: Engages with end users and cross-functional process teams to evaluate change impacts and recommend solutions to facilitate smooth adoption of new processes and technologies.
  • COMMUNICATION & KNOWLEDGE TRANSFER: Provides regular updates on deployment progress, risks and process related key decisions, and ensures process leaders, teams and users are equipped with the right knowledge to sustain the new process or technology.
Qualifications

Minimum Qualifications:

  • Minimum requirement of 4 years of relevant work experience. Typically reflects 5 years or more of relevant experience.

Preferred Qualifications:

  • Experience with SalesForce

Equal Opportunity Employer, including Disability/Vet


To apply using chat/text, please click Apply Now button OR use this link to create a login to apply.

What Cargill employees say

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About Cargill

Sourced by ZipRecruiter

Cargill was founded in 1865 as a single grain warehouse in Iowa, U.S. Since then, we’ve grown to become a global partner connecting people around the planet. But one thing has remained constant over the years: our purpose of nourishing the world in a safe, responsible and sustainable way. Cargill is committed to conducting business with integrity, operating responsibly, enriching communities and nourishing the world. In the fiscal year 2021, Cargill provided $110.5 million in total charitable contributions in 56 countries to support our communities. Cargill businesses and employee-led groups partner with local civic, nonprofit and non-governmental organizations on programs and projects that improve food security and nutrition; support human rights, equity and inclusion; strengthen farmer livelihoods; and advance our commitments in the areas of land use, water and climate.

Industry

Food and drink manufacturing

Company size

10,000+ Employees

Headquarters location

Minneapolis, MN, US

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