Remote Utilization Management Specialist

Humana, Inc.; Honolulu (HI); Remote; USD 40,000 - 52,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Disability and life insurance

Job summary

Humana, Inc. is seeking a remote UM Administration Coordinator to support utilization management operations and back-office tasks.

You will handle provider and member calls, process prior authorizations, and maintain accurate records across multiple systems while meeting SLAs. The role requires at least 2 years of customer service experience, strong typing (≥30 wpm), proficiency with Microsoft Office, and a dedicated home workspace with a wired internet connection.

Qualifications

• Minimum of 2 years of customer service experience.
• Experience managing a high-volume of calls (approximately 30 to 50 calls daily) using multiple computer systems while engaging callers.
• Typing proficiency of at least 30 words per minute.
• Proficient experience using Microsoft Office (including toolbars, menus, and system features to locate documents).
• A direct wired connection to an internet router is required (Wi-Fi is not permitted).
• A dedicated, distraction-free, professional workspace with a closed door (ability to participate in meetings and training with a webcam).

Responsibilities

• Handle inbound and outbound calls about prior authorizations, utilization management services, and benefits; help providers and members navigate these processes, with approximately 30 to 50 phone interactions daily when assigned to phone support.
• Process and review prior authorization requests and documentation, researching and evaluating information to support medical necessity determinations and authorization workflows.
• Perform back-office administrative tasks, including case research, record updates, error resolution, and timely case processing.
• Review, verify, and enter accurate information across multiple systems; document all interactions, research findings, and case activities while following established procedures, process flows, and work instructions.
• Complete and monitor assigned work queues to meet service level agreements and turnaround time requirements.
• Collaborate with clinical and operational teams and internal partners to resolve issues and address escalated concerns.

Skills

Customer service

High-volume calls

Typing 30 wpm

Microsoft Office

Wired internet

Remote workspace

Job description

Humana, Inc. is seeking a remote UM Administration Coordinator to support utilization management operations and back-office tasks.

You will handle provider and member calls, process prior authorizations, and maintain accurate records across multiple systems while meeting SLAs. The role requires at least 2 years of customer service experience, strong typing (≥30 wpm), proficiency with Microsoft Office, and a dedicated home workspace with a wired internet connection.