[Hiring] Healthcare Utilization Specialist @Cobalt Benefits Group Llc

Cobalt Benefits Group Llc; Deutschland; Remote; EUR 40.000 - 60.000; Vollzeit

Zusammenfassung

A premier healthcare benefits firm is hiring a remote Healthcare Utilization Specialist. You will review claims for medical necessity and work with clinical teams to ensure effective utilization management. The ideal candidate should have a background in healthcare para-professions and be adept in coding and insurance processes. A comprehensive benefits package is offered after a brief waiting period.

Leistungen

Medical, dental, and vision insurance

Employer HSA contribution

Company paid insurance benefits

401(k) with employer-match

Generous vacation and sick time

Qualifikationen

• Prior training in coding, insurance, or basic medical vocabulary preferred.
• Fluent computer skills essential.
• Strong reading comprehension required.
• Self-motivated individuals thrive in this role.
• Ability to make sound decisions independently.

Aufgaben

• Review claims for medical necessity and authorization status.
• Support daily operations of the Utilization Review department.
• Conduct outreach calls and maintain productivity standards.
• Process correspondence and faxes following timelines.
• Perform clerical tasks like scanning and document retrieval.

Kenntnisse

Prior training in coding

Fluent computer skills

Strong reading comprehension

Self-motivated

Logical decision-making

Ausbildung

Medical assistant training or certification

Home health aide training or certification

Nursing assistant training or certification

Tools

MS Office (Word, Excel, Outlook)

Jobbeschreibung

Overview

sep 01, 2025 - Cobalt Benefits Group Llc is hiring a remote Healthcare Utilization Specialist. Salary: 22.00 - 24.00. Location: USA. Job Type: Full-time. Apply online.

About Us

Join our team at Company and build a meaningful career in employee benefits solutions. As a Healthcare Utilization Specialist, you’ll play a vital role in ensuring our clients and members receive the right care at the right time through customized, self-funded insurance programs. You’ll review claims for medical necessity, verify authorizations, and collaborate across clinical and administrative teams to support effective utilization management.

Position Summary

Reporting to the Utilization Review Manager, the Utilization Review Specialist will coordinate reviews of group renewal information, process claims for medical necessity, and determine whether authorizations are on file. Make determinations for claims processing based upon coding. This position involves interpretation of medical data, coordination of review processes, and collaboration with clinical and administrative teams to support effective utilization management. This role is ideal for detail-oriented healthcare para-professionals who want to apply their knowledge of medical terminology and insurance processes in a supportive, team-driven environment.

Key Responsibilities

• 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.

Qualifications

• Prior training in coding, insurance, basic medical vocabulary, training or certification in these roles preferred but not required: 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

After successfully completing a 60/90 day waiting period, eligible employees have access to our comprehensive benefits package, including:

• Fantastic medical, dental, and vision insurance with twice annual employer HSA contribution, covering 50% of the plan’s annual deductible
• Company paid 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
• 10+ paid holidays
• Generous paid vacation and sick time
• Lots of fun company events

Who We Are

As a trusted third-party administrator (TPA) specializing in self-funded benefit plans, Cobalt Benefits Group (CBG) is committed to helping employers find high-quality coverage at a cost they can afford. We administer self-funded insurance benefits through our three companies: EBPA, Blue Benefit Administrators of Massachusetts, and CBA Blue. We have over 30 years of experience and a dedicated team of more than 180 employees, working to build customized self-funded health plans, manage claim payments and disputes, and administer other programs such as FSAs, HSAs, COBRA, and retiree billing.

To learn more about working at CBG, visit Careers | EBPA (ebpabenefits.com).