Remote Utilization & Prior Authorization Coordinator

Humana, Inc.; San Juan (PR); Remote; USD 40,000 - 52,000; Full time

Benefits offered by this job

Medical benefits

401(k) plan

Paid time off

Disability insurance

Life insurance

Job summary

Humana, Inc. is seeking an UM Administration Coordinator to support UM operations through provider and member-facing phone support and back-office tasks. This remote role reports to the Supervisor, UM Management and requires flexible scheduling with weekend and holiday rotation.

The position emphasizes handling prior authorizations, utilization management, and documentation across multiple systems while maintaining service levels and high-quality member care.

Qualifications

• Minimum 2 years of customer service experience.
• Experience handling 30–50 inbound/outbound calls daily across multiple systems.
• Typing speed of at least 30 wpm.
• Proficient use of Microsoft Office and online tools.
• Wired internet connection required (no Wi-Fi).
• Dedicated, distraction-free home workspace with webcam for meetings.

Responsibilities

• Handle inbound and outbound calls about prior authorizations, utilization management, and benefits.
• Process and review prior authorization requests and documentation for medical necessity determinations.
• Perform back-office administrative tasks including case research and data entry.
• Document interactions and research findings across multiple systems following procedures.
• Monitor work queues to meet service levels and turnaround times.
• Collaborate with clinical and operational teams to resolve issues.

Skills

Customer service

High-volume calls

Typing (30 wpm)

MS Office

Wired internet

Remote work readiness

Tools

Microsoft Office

Job description

Humana, Inc. is seeking an UM Administration Coordinator to support UM operations through provider and member-facing phone support and back-office tasks. This remote role reports to the Supervisor, UM Management and requires flexible scheduling with weekend and holiday rotation.

The position emphasizes handling prior authorizations, utilization management, and documentation across multiple systems while maintaining service levels and high-quality member care.