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Remote Insurance Utilization Review Jobs in Madison, WI

WPS

Medical Review Nurse Analyst

Madison, WI · On-site +1

$68K - $70K/yr

Experience with medical record review or utilization review. Remote Work Requirements * Wired ... Health insurance, dental insurance, and telehealth services start DAY 1 * Professional and ...

WPS Health Solutions

Medical Director

Madison, WI · On-site +1

Three (3) or more years of experience in the health insurance industry, a utilization review firm ... Remote Work Requirements * Wired (ethernet cable) internet connection from your router to your ...

WPS

Medical Director

Madison, WI · On-site +1

Three (3) or more years of experience in the health insurance industry, a utilization review firm ... Remote Work Requirements * Wired (ethernet cable) internet connection from your router to your ...

LEARN Behavioral

RCM Coordinator (Remote)

Madison, WI · Remote

$24/hr

... review, denial resolution, appeals, and follow-up to maximize reimbursement and reduce accounts ... Partner with Clinical Operations, Utilization Management, Credentialing, and other cross-functional ...

WPS

Senior Account Manager - Health Insurance

Madison, WI · On-site +1

$85K - $105K/yr

Please review Remote Worker FAQs for additional information Benefits * Remote and hybrid work ... Health insurance, dental insurance, and telehealth services start DAY 1 * Professional and ...

MDS Solutions

REMOTE MDS Coordinator

Madison, WI · Remote

$34.50 - $44/hr

Comprehensive health and life insurance. * 401K with discretionary match * Mileage and licensure ... Review and verify MDS documentation and charting requirements to support the clinical services ...

Beacon Technologies

Life Underwriter

Madison, WI · Remote

$30 - $32/hr

Conduct comprehensive audits and re-underwriting reviews of individual life insurance policies ... Ability to work independently in a remote environment while maintaining productivity and quality ...

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Remote Insurance Utilization Review information

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$69

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

As of Jul 27, 2026, the average hourly pay for remote insurance utilization review in Madison, WI is $42.60, according to ZipRecruiter salary data. Most workers in this role earn between $33.65 and $48.94 per hour, depending on experience, location, and employer.

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 Madison, WI? For Remote Insurance Utilization Review jobs in Madison, WI, the most frequently searched job titles are:
What job categories do people searching Remote Insurance Utilization Review jobs in Madison, WI look for? The top searched job categories for Remote Insurance Utilization Review jobs in Madison, WI are:
Remote Insurance Utilization Review jobs near you
Infographic showing various Remote Insurance Utilization Review job openings in Madison, WI as of June 2026, with employment types broken down into 65% Full Time, 26% Part Time, 3% Temporary, 3% Contract, and 3% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $88,617 per year, or $42.6 per hour.
Medical Review Nurse Analyst

Medical Review Nurse Analyst

WPS

Madison, WI • On-site, Remote

$68K - $70K/yr

Full-time

Medical, Dental, Retirement, PTO

Posted 10 days ago

Job description

Our Medical Review Nurse Analyst is responsible for conducting clinical reviews of medical records to ensure compliance with regulatory and payer guidelines. This analyst ensures that providers are being reimbursed appropriately for services provided based on Medicare guidelines. This Medical Review Nurse Analyst reviews claims and delivers provider education on current billing and documentation requirements.
Salary Range$68,000 - $70,000The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.We are open to remote work in the following approved states:Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin
How do I know this opportunity is right for me? If you:
  • Can perform detailed reviews of medical records and documentation to determine the medical necessity of services.
  • Would enjoy reviewing submitted claims to ensure that billed services are medically necessary and correctly coded based on Medicare guidelines.
  • Want to ensure Medicare providers are correctly reimbursed when documentation supports services rendered.
  • Have prepared written clinical summaries and determinations with clear rationale for approvals, denials, or modifications.
  • Would like to educate providers in accordance with the Targeted Probe and Educate (TPE) program.
  • Can monitor the progress of assigned providers and educate on current billing and documentation requirements.
  • Want to ensure compliance with federal and state regulations, CMS guidelines, and company policies.
  • Enjoy staying current on clinical guidelines, medical policy updates, and industry best practices.

Minimum Qualifications
  • Associate's (ASN) or Bachelor's Degree in Nursing (BSN).
  • Active RN license, applicable to state of practice in good standing.
  • 1 or more years of clinical experience in a healthcare setting (hospital, homecare, skilled nursing, etc.).
  • Excellent written and verbal communication skills, with the ability to communicate complex medical information clearly and concisely.
  • Strong attention to detail and organizational skills to manage multiple cases simultaneously.
  • Basic knowledge and understanding of medical/clinical review processes.
  • Solid computer skills with experience working in multiple on-line systems including MS Outlook, Teams, OneNote, Word, and Excel.

Preferred Qualifications
  • Experience working for a Medicare Administrative Contractor (MAC).
  • Familiarity with Medicare guidelines and reimbursement processes.
  • Experience with medical record review or utilization review.

Remote Work Requirements
  • Wired (ethernet cable) internet connection from your router to your computer
  • High speed cable or fiber internet
  • Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net)
  • Please review Remote Worker FAQs for additional information

Benefits
  • Remote work options available
  • Performance bonus and/or merit increase opportunities
  • 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
  • Competitive paid time off
  • Health insurance, dental insurance, and telehealth services start DAY 1
  • Professional and Leadership Development Programs
  • Review additional benefits: (https://www.wpshealthsolutions.com/careers/)

Who We Are
WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.
Culture Drives Our Success
WPS' culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.
We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition.
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This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s). As such, the role is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. CMS contractors and their personnel are subject to screening and background investigation including fingerprinting prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services
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