Remote Utilization & Prior Authorization Coordinator

Humana, Inc.; Richmond (VA); Remote; USD 40,000 - 52,000; Full time

Job summary

Humana, Inc. is seeking a UM Administration Coordinator to support UM operations with provider/member-facing phone support and back-office administration.

This remote role reports to the Supervisor, UM Management and requires attendance at training, with shifts up to 8 hours ending 7:00pm CST/8:00pm EST, including one weekend day and holiday rotation. Responsibilities include handling calls about prior authorizations, reviewing requests for medical necessity, and performing back-office tasks.

Qualifications

• Minimum of 2 years of customer service experience.
• Experience handling a high-volume of calls (30–50 daily).
• Typing proficiency of at least 30 words per minute.
• Proficient experience using Microsoft Office.
• Direct wired internet connection required (Wi‑Fi not permitted).
• Dedicated, distraction-free workspace with webcam for meetings.

Responsibilities

• Handle inbound and outbound calls about prior authorizations, utilization management services, and benefits; 30–50 daily interactions when on phone support.
• Process and review prior authorization requests and documentation for medical necessity determinations and workflows.
• Perform back-office administrative tasks including case research, record updates, error resolution, and timely processing.
• Review and enter accurate information across multiple systems; document interactions, findings, and activities.
• Complete and monitor work queues to meet SLAs and turnaround times.
• Collaborate with clinical and operational teams to resolve issues and address escalated concerns.

Skills

Customer service

Phone handling

Typing 30 wpm

MS Office

Remote work

Stable home workspace

Job description

Humana, Inc. is seeking a UM Administration Coordinator to support UM operations with provider/member-facing phone support and back-office administration.

This remote role reports to the Supervisor, UM Management and requires attendance at training, with shifts up to 8 hours ending 7:00pm CST/8:00pm EST, including one weekend day and holiday rotation. Responsibilities include handling calls about prior authorizations, reviewing requests for medical necessity, and performing back-office tasks.