Healthcare Utilization Review Specialist

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Cobalt Benefits Group, LLC (DBA: Blue Benefit Administrators, CBA Blue & EBPA)

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51 - 200 employees

Who We Are:

📋 Description

• Review claims in utilization review queues for medical necessity and authorization status; determine appropriate processing based on coding and plan language. • Support the daily operations of the Utilization Review department by assisting senior UR team members with case review activities. • Conduct outreach calls and collect data using established scripts, tools, and protocols, while maintaining productivity and service standards. • Process correspondence and faxes in accordance with timeliness standards; escalate to clinical team members when appropriate. • Perform clerical and administrative tasks, including scanning, document retrieval, and urgent claims processing support. • Communicate clearly, professionally, and courteously with internal and external stakeholders to resolve issues. • Provide written direction to other team members (nurses, claims auditors) to support accurate claims processing. • Maintain current knowledge of Standard Operating Procedures, member benefits, rights, and responsibilities. • Ensure compliance with BCBS Association standards and company policies. • Complete other related duties and projects as assigned.

🎯 Requirements

• Medical assistant, home health aide, nursing assistant, or other similar health care para-professional training or certification. • Fluent computer skills including MS Office (Word, Excel, and Outlook) and Internet applications. • Strong reading comprehension • Self-motivated, self-directed, operates without constant guidance. • Must be able to make sound logical decisions and articulate the reasoning.

🏖️ Benefits

• Fantastic medical, dental, and vision insurance* • Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible! • Company provided Basic Life and AD&D • Company paid Short-Term and Long-Term Disability** • Flexible Spending Accounts* • 401(k) Retirement Plan with up to a 6% employer-match** • WOW! (100% fully vested after 3 years) • 10+ paid holidays • Generous paid vacation and sick time • Annual Volunteer Paid Day • Annual Tuition Reimbursement • Annual Health and Wellness Reimbursement • Lots of fun company events