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Remote Utilization Management Jobs in Wisconsin (NOW HIRING)

WPS

Senior IT Security Analyst

Madison, WI · On-site +1

$90K - $115K/yr

... management, compliance tracking, and reporting. This Senior Analyst combines deep knowledge of ... S econdary consideration will be given to remote candidates in Wisconsin, Illinois, Michigan ...

Becton, Dickinson and Company

$125K - $207K/yr

... utilization of our innovative solutions. Responsibilities * Achieve established sales goals and ... Remote or field-based positions will have different workplace arrangements which will be indicated ...

SHINE Technologies LLC

Licensing Manager

Janesville, WI · On-site +1

$160K - $200K/yr

Hybrid or remote work arrangement will be considered. While our headquarters is located in ... Demonstrated knowledge of regulatory guidance applicable to non-power production and utilization ...

AVID

Enterprise Customer Success Manager

Montreal, WI · Remote

$139K - $167K/yr

... utilization of our solutions. Relationship Management * Establish and maintain strong multi ... Remote #LI-RM1 Pay Range $111K - $139K - $167K USD The salary range shown reflects the company ...

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Remote Utilization Management information

How does a remote utilization management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

What are the key skills and qualifications needed to thrive in remote utilization management?

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

What is remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

What is the difference between Remote Utilization Management vs Remote Case Management?

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

What are the most commonly searched types of Utilization Management jobs in Wisconsin? The most popular types of Utilization Management jobs in Wisconsin are:
What are popular job titles related to Remote Utilization Management jobs in Wisconsin? For Remote Utilization Management jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management jobs in Wisconsin look for? The top searched job categories for Remote Utilization Management jobs in Wisconsin are:
What cities in Wisconsin are hiring for Remote Utilization Management jobs? Cities in Wisconsin with the most Remote Utilization Management job openings:
Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Wisconsin as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution.

Large Loss & Litigation Claims Manager

Society Insurance Company

Fond Du Lac, WI • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 16 days ago

Job description

Job Information

Job Title

Large Loss & Litigation Claims Manager 

Home Department:

Claims

Employment Status:

Exempt; Full-time

Schedule:

Flexible Scheduling Opportunities 

Position Location:

Remote Worker (States include: CO, GA, IA, IL, IN, MN, TN, TX, WI)

 

This position offers flexible remote/hybrid work scheduling and we are targeting candidates who are located within the 9 states which Society conducts business in. Visit us at https://societyinsurance.com/ to learn more.

 

 

Overview

Protecting our policyholders’ dreams, passions, and livelihoods has a direct impact on the communities we serve. We work towards excellence, conduct ourselves with high integrity, and take our work seriously, but not ourselves. Small Details. Big Difference. Find out how you can make a difference with a career at Society.

Society Insurance is seeking an experienced Large Loss & Litigation Claims Manager to join our Claims team. The Large Loss and Litigation Claims Manager is responsible for leading the strategic oversight, direction, and resolution of complex, high-exposure commercial lines claims, including litigated matters and large loss files. This position provides technical guidance and leadership to claims professionals, collaborates with internal stakeholders and outside counsel, evaluates coverage and liability issues, and ensures claims are handled in accordance with company standards, regulatory requirements, and sound claim practices. The role requires strong judgment, advanced claims expertise, effective litigation management skills, and the ability to coach, develop, and support team members while driving fair, timely, and financially responsible claim outcomes.

About the Role 

  • Collaborates with Underwriting, Risk Control, and Marketing by providing feedback on claims trends.
  • Builds, maintains, and monitors key litigation metrics that drive strategic results that align closely with the pre-suit file handlers and management team in Claims. 
  • Utilizes department key performance measures and audit results as a tool for coaching adjusters.
  • Monitors state and department results and making adjustments to strategy as needed.
  • Maintains staff by recruiting, selecting, and training employees. Develops staff by coaching, mentoring, training, and providing personal growth opportunities. 
  • Provides staff with recommendations and actions to take when reviewing and analyzing damages, coverages, and liability issues.
  • Provides quality service by maintaining claims support quality and customer service standards, analyzing, initiating audits, and recommending system improvements.
  • Reviews department-related expenses for reasonableness and necessity.
  • Accomplishes claims support operations by managing claims support process; evaluating work results; and enforcing claims support productivity standards. 
  • Approves coverage counsel when needed and oversees training and development of House Counsel in being lead defense on cases.
  • Identifies the best use for House Counsel and identifies metrics to evaluate performance.
  • Directs defense of policyholders, legal guidance for claim representatives and company legal needs, or industry legal involvement.
  • Conducts audits on large losses and suit files; creates an audit database that focuses on expense control methods and key skills and/or strategies needed for successful resolution of suit cases.
  • Maintains a trial calendar and monitors cases for early review of pre-trial reports, conducts strategizing sessions with claim representatives, and submits case strategy to Claims Director. 
  • Manages litigation, processes and procedures, and vendor utilization and expense management.
  • Creates a review process of large exposure losses to ensure regular interaction with the claim representative and manager and ensures direction and strategy is clearly documented.
  • Provides Claims Director status updates of teams’ cases with resolution strategies and provides updates on all projects including hurdles and resource needs.
  • Provides legal updates and jury verdict results to Claim Managers on a quarterly basis.
  • Develops training programs and identifies expert speakers to address training needs of the department, and creates and educates department on litigation reduction programs.
  • Identifies, creates, and maintains monthly, quarterly, and annual reports needed by the Claims Director and department managers.


About You 

  • You enjoy coaching developing others.
  • You make timely decisions and take appropriate action – even when information is incomplete.
  • You assign responsibilities effectively and empowers others to take ownership.
  • You achieve goals by taking action, staying focused, and holding yourself and others accountable.
  • You use data, evidence, and sound judgment to make informed decisions.
  • You build commitment and morale while navigating organizational dynamics.
  • You design and improve processes to enhance efficiency and results.
  • You foster collaboration and trust to help teams work toward shared goals.


What it Will Take

  • Bachelors degree in business or related field and 10 years of experience in the direct handling of large loss and litigated files
     
     OR
     
     14 years of experience in the direct handling of large losses, litigated files and/or large property claims including investigations of auto accidents, liability claims, and fire losses (cause-and-origin) and subrogation.
  • Experience managing a team of claim representatives.
  • Ability to obtain and maintain proper licensing prior to handling a state where Society requires it.
  • Demonstrated commitment to ongoing professional development through on-the-job learning, insurance designations, seminars, conferences, or other relevant learning opportunities. 
  • Valid driver’s license and a satisfactory driving record.
  • Strong organizational skills and excellent verbal and written communication skills.
  • At least 5 years of experience managing a team of claims representatives highly desirable.


What Society Can Offer 

  • Comprehensive Benefits Package: Salary with bonus plan; health, dental, life, and vision insurance
  • Retirement: Traditional or Roth 401(k) Defined Contribution Plan PLUS Profit-Sharing Plan
  • Work-Life Balance: Company-paid holidays; flexible scheduling; PTO; telecommuting options
  • Education: Career Coaching; company-paid courses; student loan and tuition reimbursement
  • Community: Charitable Match; paid volunteer time; team sponsorships
  • Wellness: Employee Assistance Program; wellness initiatives/rewards; health coaching; and more


Society Insurance prohibits discrimination and harassment of any type against applicants and employees on the basis of race, color, religion, sex, national origin, age, handicap, disability, genetics, veteran status or military service, marital status or sexual orientation, gender identity or expression, or any other characteristic or status protected by federal, state or local laws. Society Insurance also provides reasonable accommodations to qualified individuals with disabilities in accordance with the requirements of the Americans with Disabilities Act and applicable state and local laws.


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