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Remote Insurance Utilization Review Jobs in Gainesville, FL

TEW & TAYLOR

Remote Plans Examiner

Gainesville, FL · Remote

$80K - $100K/yr

Health insurance * Paid time off About Us: Tew & Taylor has been a trusted name in building code ... As a Plan Reviewer at Tew & Taylor, you will play a critical role in ensuring compliance with ...

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Remote Insurance Utilization Review information

See Gainesville, FL salary details

$19

$38

$62

How much do remote insurance utilization review jobs pay per hour?

As of Sep 12, 2026, the average hourly pay for remote insurance utilization review in Gainesville, FL is $38.31, according to ZipRecruiter salary data. Most workers in this role earn between $30.29 and $43.99 per hour, depending on experience, location, and employer.

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 Gainesville, FL?

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

What job categories do people searching Remote Insurance Utilization Review jobs in Gainesville, FL look for?

The top searched job categories for Remote Insurance Utilization Review jobs in Gainesville, FL are:

What cities near Gainesville, FL are hiring for Remote Insurance Utilization Review jobs?

Cities near Gainesville, FL with the most Remote Insurance Utilization Review job openings:

Remote Insurance Utilization Review jobs near you
Infographic showing various Remote Insurance Utilization Review job openings in Gainesville, FL as of August 2026, with employment types broken down into 94% Full Time, and 6% Contract. Highlights an 100% Remote job distribution, with an average salary of $79,680 per year, or $38.3 per hour.

Insurance Claims Support Spec

Gainesville, FL • Remote

UF Health
Health Care and Social Assistance • 10K+ employees
Learn more about UF Healthexternal

Full-time

Posted 25 days ago

Job description

Overview
Bring your claims expertise to a remote team committed to service excellence and operational success. 
 
???? Work Style: Remote (on-site training available) 
???? Location Requirement: Gainesville, FL
???? FTE: Full-Time (1.0 FTE)
 
This position is responsible for coordinating incoming and outgoing payer correspondence, reviewing claim documentation, supporting Epic account updates, and ensuring accurate claim processing and routing. Ideal candidates are detail-oriented, analytical, and thrive in a fast-paced environment while helping drive efficiency and accuracy across the revenue cycle team.

Responsibilities
Key Responsibilities
  • Manages and evaluates insurance claims to ensure accuracy and timely processing.
  • Investigates claims, reviews supporting documentation, and negotiates appropriate settlements.
  • Responds to inquiries from claimants, vendors, and related parties in a timely and professional manner.
  • Assists clients with proper claim submission and provides guidance throughout the claims process.
  • Coordinates with internal teams to facilitate efficient claim resolution and workflow management.
  • Maintains detailed and accurate records while ensuring compliance with regulatory and audit requirements.

Qualifications
Education
  • High School Diploma/Equivalent
Experience Requirements
  • 2+ years of experience in insurance claims processing and support.
  • Working knowledge of insurance policies, coverage, and claims adjudication processes.
  • Experience investigating, analyzing, and resolving claim-related issues.
  • Strong communication and customer service skills with the ability to interact effectively with claimants and stakeholders.
  • Demonstrated ability to maintain accurate records and ensure compliance with regulatory and audit requirements.

Preferred Qualifications: 

  • Experience with UB04 Billing - required

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