Utilization Management Representative I – Backoffice Support

Jobtailor; Connecticut; On-site; USD 38,000 - 52,000; Full time

Job summary

Jobtailor is seeking an experienced Utilization Management support professional to precertify, authorize, and process post-service requests for governmental and commercial health plans. The role emphasizes accuracy, HIPAA compliance, and back-office efficiency.

You will review requests from multiple channels, enter referral data into systems, and communicate with providers and internal teams. A strong customer-service background and knowledge of medical terminology are preferred.

Qualifications

• High school diploma or GED required.
• Minimum of 1 year of customer service or call-center experience.
• Administrative support, healthcare operations, data entry, document processing, or back-office experience strongly preferred.
• Medical terminology training and experience in medical or insurance field preferred.
• Strong oral, written, and interpersonal communication skills.
• Problem-solving, analytical and facilitation skills preferred.
• Ability to meet productivity, quality, accuracy, and turnaround-time expectations.

Responsibilities

• Process precertification, prior authorization, and post-service requests for governmental and commercial lines of business.
• Review and process utilization management requests received through fax, electronic queues, and other approved channels.
• Enter referral and authorization information accurately into utilization management systems.
• Prepare and send complete and accurate fax correspondence to providers, facilities, members, and internal partners.
• Meet departmental productivity, quality, accuracy, and turnaround-time standards while maintaining a low error rate.
• Review documentation for completeness and refer cases requiring clinical review to the appropriate clinical reviewer.
• Verify benefits and administrative requirements within the scope of the role.
• Document all actions and correspondence accurately and completely.
• Monitor queues, prioritize tasks, follow work through completion, and promptly elevate barriers.
• Protect confidential information and comply with HIPAA, privacy, security, company, accreditation, contractual, and regulatory requirements.
• Identify and report potential quality, privacy, compliance, or regulatory concerns through established escalation processes.
• Perform other duties as assigned.
• Primarily perform back-office work with no inbound call responsibilities; make limited outbound calls when needed to obtain information or support case resolution

Skills

Utilization Management

HIPAA Compliance

Data Entry

Customer Service Experience

Medical Terminology

Education

High school diploma or GED

Tools

Document Management Systems

Job description

• Process precertification, prior authorization, and post-service requests for governmental and commercial lines of business
• Review and process utilization management requests received through fax, electronic queues, and other approved channels
• Enter referral and authorization information accurately into utilization management systems
• Prepare and send complete and accurate fax correspondence to providers, facilities, members, and internal partners
• Meet departmental productivity, quality, accuracy, and turnaround-time standards while maintaining a low error rate
• Review documentation for completeness and refer cases requiring clinical review to the appropriate clinical reviewer
• Verify benefits and administrative requirements within the scope of the role
• Document all actions and correspondence accurately and completely
• Monitor queues, prioritize tasks, follow work through completion, and promptly elevate barriers
• Protect confidential information and comply with HIPAA, privacy, security, company, accreditation, contractual, and regulatory requirements
• Identify and report potential quality, privacy, compliance, or regulatory concerns through established escalation processes
• Perform other duties as assigned
• Primarily perform back-office work with no inbound call responsibilities; make limited outbound calls when needed to obtain information or support case resolution

Requirements

• High school diploma or GED
• Minimum of 1 year of customer service or call-center experience
• Any combination of education and experience providing an equivalent background
• Administrative support, healthcare operations, data entry, document processing, or back-office experience strongly preferred
• Medical terminology training and experience in medical or insurance field preferred
• Strong oral, written, and interpersonal communication skills
• Problem-solving skills
• Facilitation skills
• Analytical skills
• Ability to meet established productivity, quality, accuracy, compliance, and turnaround-time expectations preferred
• Ability to manage assigned work independently, maintain confidentiality, and follow detailed policies and procedures preferred
• Proficiency with computers, electronic work queues, email, and document-management systems preferred
• Experience processing faxes, referrals, authorizations, claims, medical records, or healthcare correspondence preferred
• Knowledge of HIPAA and healthcare privacy requirements preferred
• Experience working in a high-volume, production-based, compliance-focused environment preferred
• Availability to work an assigned Monday-Friday shift between 8:00 a.m. and 8:00 p.m. Eastern Time
• Must comply with HIPAA, privacy and security requirements, company policies, accreditation standards, contractual obligations, and applicable federal and state regulations
• New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless an acceptable explanation is provided

Core Competencies

Demonstrates proficiency in processing precertification, prior authorization, and post-service requests while adhering to HIPAA and regulatory requirements. Capable of managing tasks independently in a high-volume, compliance-focused environment with strong communication and problem-solving skills.

Highest-signal resume keywords

• Utilization Management
• HIPAA Compliance
• Data Entry
• Customer Service Experience
• Medical Terminology

ATS Optimization Keywords

Hard Skills

• Precertification Processing
• Prior Authorization
• Document Processing
• Referral Management
• Claims Processing
• Healthcare Correspondence
• Analytical Skills
• Problem-Solving Skills
• Quality Assurance
• Compliance Managementi>