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Remote Insurance Utilization Review Jobs in Toronto, ON

Mercor

Senior Insurance Underwriting Specialist

Toronto, ON · Remote

CA$50 - CA$60/hr

Remote Role Responsibilities * Construct enterprise insurance scenarios for complex commercial underwriting, multi-stakeholder claims adjudication, and regulatory compliance review cycles at Fortune ...

Mercor

Senior Insurance Underwriting Specialist

Toronto, ON · Remote

CA$50 - CA$60/hr

Remote Role Responsibilities * Construct enterprise insurance scenarios for complex commercial underwriting, multi-stakeholder claims adjudication, and regulatory compliance review cycles at Fortune ...

Cayenta

(Remote) Application Consultant

Guelph, ON · Remote

... reviews & documentation, requirements elicitation, allowing the project team to gain a ... to exceptional utilization of assigned resources. * Be a leader in providing subject matter ...

Cayenta

(Remote) Application Consultant

Markham, ON · Remote

... reviews & documentation, requirements elicitation, allowing the project team to gain a ... to exceptional utilization of assigned resources. * Be a leader in providing subject matter ...

Cayenta

(Remote) Application Consultant

Toronto, ON · Remote

... reviews & documentation, requirements elicitation, allowing the project team to gain a ... to exceptional utilization of assigned resources. * Be a leader in providing subject matter ...

Cayenta

(Remote) Application Consultant

Oakville, ON · Remote

... reviews & documentation, requirements elicitation, allowing the project team to gain a ... to exceptional utilization of assigned resources. * Be a leader in providing subject matter ...

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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 Toronto, ON?

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

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

The top searched job categories for Remote Insurance Utilization Review jobs in Toronto, ON are:

Remote Insurance Utilization Review jobs near you

Healthcare Workflow Specialist - Fully Remote | Upto $80/hr

Toronto, ON • Remote

Mercor
See more jobs at Mercorexternal

CA$80/hr

Full-time

Re-posted 27 days ago

Job description

About the job

Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst, Peter Thiel, Adam D'Angelo, Larry Summers, and Jack Dorsey.

Position: Registered Nurses (Data labelling and training)
Type: Contract
Compensation: $60–$80/hour
Location: Remote

Role Responsibilities

  • Review and assess clinical documentation for accuracy, completeness, and quality.
  • Analyze healthcare workflows and recommend process improvements.
  • Interpret patient records and clinical notes to support product development.
  • Identify documentation gaps, inconsistencies, and edge cases.
  • Collaborate with product, engineering, and operations teams to refine AI-driven healthcare tools.
  • Ensure adherence to healthcare regulations, policies, and best practices.

Qualifications

Must-Have

  • Active Registered Nurse (RN) license.
  • 3–5+ years of clinical nursing experience.
  • Strong understanding of clinical documentation and healthcare workflows.
  • Experience working with EHR systems (Epic, Cerner, Meditech, etc.).
  • Excellent analytical, communication, and problem-solving skills.

Preferred

  • Experience in CDI, case management, utilization review, or quality improvement.
  • Exposure to healthcare technology, AI tools, or digital health products.
  • Ability to collaborate effectively with cross-functional teams.

Application Process (Takes 20–30 mins to complete)

  • Upload resume
  • AI interview based on your resume
  • Submit form

Resources & Support

  • For details about the interview process and platform information, please check: https://talent.docs.mercor.com/welcome
  • For any help or support, reach out to: support@mercor.com

PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.