Remote Utilization Review Specialist for Healthcare Claims

Socket.dev; Austin (TX); On-site; USD 60,000 - 75,000; Full time

Job summary

Socket.dev is seeking a Utilization Review Specialist in Exeter, NH or remote options to support our healthcare operations. You will prepare and coordinate group renewal reviews, assess medical necessity of claims, and apply coding rules under supervision.

You will collaborate with clinical and administrative teams, maintain UR process knowledge, and handle outreach calls and data collection per scripts and protocols, ensuring timely, accurate review decisions for members and providers.

Qualifications

• One or more years in healthcare payer or utilization review.
• Experience reviewing healthcare claims and applying review criteria.
• Ability to interpret health plan language and coding basics.

Responsibilities

• Supports UR department operations with various tasks.
• Maintains knowledge of UR processes and timelines.
• Conducts calls and data collection per scripts and protocols.
• Refer to clinical staff for review as defined by workflow.
• Adheres to SOPs and member benefits information.
• Processes claims within BCBS standards.

Skills

Healthcare payer

Claims review

Medical terminology

Analytical thinking

Communication skills

Microsoft Office

Tools

Microsoft Word

Excel

Outlook

Job description

Socket.dev is seeking a Utilization Review Specialist in Exeter, NH or remote options to support our healthcare operations. You will prepare and coordinate group renewal reviews, assess medical necessity of claims, and apply coding rules under supervision.

You will collaborate with clinical and administrative teams, maintain UR process knowledge, and handle outreach calls and data collection per scripts and protocols, ensuring timely, accurate review decisions for members and providers.