Remote Utilization & Prior Authorization Coordinator

Humana, Inc.; Phoenix (AZ); Remote; USD 40,000 - 52,000; Full time

Job summary

Humana, Inc. is seeking an UM Administration Coordinator to support UM operations through provider and member phone support and back-office tasks. This remote role reports to the Supervisor, UM Management and involves an 8-hour shift with one weekend day and holiday rotation.

Training begins with mandatory sessions 8:00 AM–4:30 PM CST for the first month. Expect cross-training across lines of business and utilization management functions, with strong emphasis on reliability and customer service

Qualifications

• Minimum of 2 years of customer service experience.
• Experience handling 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 using 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 experience

High-volume calls

Typing 30 wpm

Microsoft Office

Wired internet required

Webcam for meetings

EMR systems

Job description

Humana, Inc. is seeking an UM Administration Coordinator to support UM operations through provider and member phone support and back-office tasks. This remote role reports to the Supervisor, UM Management and involves an 8-hour shift with one weekend day and holiday rotation.

Training begins with mandatory sessions 8:00 AM–4:30 PM CST for the first month. Expect cross-training across lines of business and utilization management functions, with strong emphasis on reliability and customer service