Healthcare Utilization Reviewer: Claims & Care Optimization

Socket.dev; Houston (TX); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Medical, dental and vision insurance

401(k) with employer match

Paid holidays

Job summary

Cobalt Benefits Group in Houston, TX, seeks a Healthcare Utilization Review Specialist to review claims for medical necessity, verify authorizations, and support utilization management in a team-driven environment.

You will interpret medical data, coordinate review processes, and ensure compliance with BH standards and SOPs while delivering timely processing and service to clients and members.

Qualifications

• Strong reading comprehension required.
• Self-motivated, able to work independently.
• Able to make sound logical decisions and articulate reasoning.

Responsibilities

• Review claims in UR queues for medical necessity and authorization status.
• Assist UR team with case review activities.
• Conduct outreach calls and collect data using established scripts and protocols.
• Process correspondence and faxes per timeliness standards.
• Perform clerical and administrative tasks including scanning and urgent claims processing support.
• Coordinate with nurses, claims auditors and other staff to ensure accurate claims processing.

Skills

Reading comprehension

Self-motivated

Decision making

MS Office

Education

Medical assistant training or certification

Nursing assistant training

Tools

MS Office (Word, Excel, Outlook)

Job description

Cobalt Benefits Group in Houston, TX, seeks a Healthcare Utilization Review Specialist to review claims for medical necessity, verify authorizations, and support utilization management in a team-driven environment.

You will interpret medical data, coordinate review processes, and ensure compliance with BH standards and SOPs while delivering timely processing and service to clients and members.