Cobalt Benefits Group LLC - Healthcare Utilization Specialist - Full-time

!DOCTYPE htmlhtml prefix="og: http://ogp.me/ns#" lang="en"head link rel="dns-prefetch" href="//www.googletagmanager.com" link rel="dns-prefetch" href="//ajax.googleapis.com" link rel="dns-prefetch" href="//cdnjs.cloudflare.com" meta charset="utf-8" meta property="og:url" content="https://recruiting.paylocity.com/Recruiting/Jobs/Details/3531377" meta property="og:image" content="https://recruiting.paylocity.com/Recruiting/Jobs/GetLogoFileById?logoFileStoreId=119789094amp;moduleId=2400" meta property="og:title" content="Cobalt Benefits Group LLC - Healthcare Utilization Specialist" meta property="og:description" content="About UsJoin our team at Company and build a meaningful career in employee benefits solutions. As a Healthcare Utilization Specialist, you’ll play a vital role in ensuring our clients and members receive the right care at the right time through customized, self-funded insurance programs. You’ll review claims for medical necessity, verify authorizations, and collaborate across clinical and administrative teams to support effective utilization management.Position SummaryReporting to the Utilization Review Manager, the Utilization Review Specialist will coordinate reviews of group renewal information, process claims for medical necessity, and determine whether authorizations are on file. Make determinations for claims processing based upon coding. This position involves interpretation of medical data, coordination of review processes, and collaboration with clinical and administrative teams to support effective utilization management. This role is ideal for detail-oriented healthcare para-professionals who want to apply their knowledge of medical terminology and insurance processes in a supportive, team-driven environment.Key ResponsibilitiesReview claims in utilization review queues for medical necessity and authorization status; determine appropriate processing based on coding and plan language.Support the daily operations of the Utilization Review department by assisting senior UR team members with case review activities.Conduct outreach calls and collect data using established scripts, tools, and protocols, while maintaining productivity and service standards.Process correspondence and faxes in accordance with timeliness standards; escalate to clinical team members when appropriate.Perform clerical and administrative tasks, including scanning, document retrieval, and urgent claims processing support.Communicate clearly, professionally, and courteously with internal and external stakeholders to resolve issues.Provide written direction to other team members (nurses, claims auditors) to support accurate claims processing.Maintain current knowledge of Standard Operating Procedures, member benefits, rights, and responsibilities.Ensure compliance with BCBS Association standards and company policies.Complete other related duties and projects as assigned." meta property="og:type" content="website" meta name="google" content="notranslate" meta http-equiv="Content-Language" content="en" meta name="viewport" content="width=device-width, initial-scale=1.0" titleCobalt Benefits Group LLC - Healthcare Utilization Specialist/title link rel="preload" as="style" href="/Recruiting/Content/citrus" onload="this.onload=null;this.rel='stylesheet';" link rel="preload" as="style" href="/Recruiting/Content/public.jobs.details.uncss.css" onload="this.onload=null;this.rel='stylesheet';" link rel="preload" as="style" href="/Recruiting/Content/public.jobs.details.css" onload="this.onload=null;this.rel='stylesheet';" link href="/Recruiting/dist/public-job-details/public-job-details-bundle.css?ver=1756487910970" rel="stylesheet" link rel="shortcut icon" href="https://cdn.paylocity.com/cdn/branding/favicon.ico" /head body class="citrus branding-background-color" citrus-banners/citrus-banners noscript h2In order to use this site, it is necessary to enable JavaScript./h2 h3 Here are the a href="https://www.enable-javascript.com/"instructions how to enable JavaScript in your web browser/a. /h3 /noscript div class="container body-content" style="display: none;" id="applicant-tracking" div class="ats-content-container branding-font" div classname="pcty-row" id="breadcrumb" div classname="pcty-col-xs-12" style="padding-top: 16px; padding-left: 16px; padding-right: 16px;" span style="display: block; float: left; min-width: 70px; max-width: 200px; " a href="https://recruiting.paylocity.com/recruiting/jobs/All/2f4c70ba-44de-4958-af36-0fbada0e1110/Cobalt-Benefits-Group-LLC" class="breadcrumb-link" title="All Jobs"All Jobs/a nbsp;gt;nbsp; /span span class="breadcrumb-title"Healthcare Utilization Specialist/span br /div /div div class="header-title" id="LayoutLogoSection" style="visibility: hidden; text-align: center;" header a href="https://drive.google.com/file/d/1PfzFBFvTZN6E-FSmBO-AXfEqsrirBoiO/view?usp=drive_link" rel="noreferrer" target="{'_blank'}" img id="LayoutLogoImage" src="/Recruiting/Jobs/GetLogoFileById?logoFileStoreId=119789093amp;moduleId=2400" class="branding-company-logo" onerror="this.style.display = 'none';document.getElementById('LayoutLogoName').style.display = 'block';" h2 id="LayoutLogoName" style="display: none;"Cobalt Benefits Group LLC/h2 /a /header /div div class="citruslike-container job-preview" role="main" div style="min-height: 50px;" div class="preview-upper-apply-btn" data-automation-id="btnPublicApply" a class="apply-link-marker button right model-full-width preview-button-color mobile-hidden apply-button branding-button-color" href="/Recruiting/Jobs/Apply/3531377" onclick="" style=""Apply/a /div div class="job-preview-header" span class="job-preview-title left" spanHealthcare Utilization Specialist/span /span br div class="preview-location" Fully Remote span • /span Tampa, FL span • /span Claims /div /div div div id="app"/div /div /div div class="job-preview-details" div class="mobile-apply-btn" a class="apply-link-marker button apply-button model-full-width branding-button-color" href="/Recruiting/Jobs/Apply/3531377" onclick="" style="width: 100%;"Apply/a /div div class="vertical-padding" div class="job-listing-header"Job Type/div divFull-time/div /div div class="job-listing-header"Description/div divpstrongAbout Us/strong/ppbr/ppJoin our team at Company and build a meaningful career in employee benefits solutions. As a Healthcare Utilization Specialist, you’ll play a vital role in ensuring our clients and members receive the right care at the right time through customized, self-funded insurance programs. You’ll review claims for medical necessity, verify authorizations, and collaborate across clinical and administrative teams to support effective utilization management./ppbr/ppstrongPosition Summary/strong/ppbr/ppReporting to the Utilization Review Manager, the Utilization Review Specialist will coordinate reviews of group renewal information, process claims for medical necessity, and determine whether authorizations are on file. Make determinations for claims processing based upon coding. This position involves interpretation of medical data, coordination of review processes, and collaboration with clinical and administrative teams to support effective utilization management. This role is ideal for detail-oriented healthcare para-professionals who want to apply their knowledge of medical terminology and insurance processes in a supportive, team-driven environment./ppbr/ppstrongKey Responsibilities/strong/pulliReview claims in utilization review queues for medical necessity and authorization status; determine appropriate processing based on coding and plan language./liliSupport the daily operations of the Utilization Review department by assisting senior UR team members with case review activities./liliConduct outreach calls and collect data using established scripts, tools, and protocols, while maintaining productivity and service standards./liliProcess correspondence and faxes in accordance with timeliness standards; escalate to clinical team members when appropriate./liliPerform clerical and administrative tasks, including scanning, document retrieval, and urgent claims processing support./liliCommunicate clearly, professionally, and courteously with internal and external stakeholders to resolve issues./liliProvide written direction to other team members (nurses, claims auditors) to support accurate claims processing./liliMaintain current knowledge of Standard Operating Procedures, member benefits, rights, and responsibilities./liliEnsure compliance with BCBS Association standards and company policies./liliComplete other related duties and projects as assigned./li/ul/div div class="job-listing-header"Requirements/div div data-bind="html: Job.Requirements"pstrongQualifications:/strong/pulli(Prior training in coding, insurance, basic medical vocabulary, training or certification in these roles preferred but not required:) Medical assistant, home health aide, nursing assistant, or other similar health care para-professional training or certification./li/ulp• Fluent computer skills including MS Office (Word, Excel, and Outlook) and Internet applications./pp• Strong reading comprehension/pp• Self-motivated, self-directed, operates without constant guidance./pp• Must be able to make sound logical decisions and articulate the reasoning./ppbr/ppstrongBenefits:/strong/ppAfter successfully completing a 60/90day waiting period, eligible employees have access to our comprehensive benefits package, including:/ppbr/pp• Fantastic medical, dental, and vision insurance- twice annual employer HSA contribution, covering 50% of the plan’s annual deductible!/pp• Company paid Basic Life and ADamp;D/pp• Company paid Short-Term and Long-Term Disability/pp• Flexible Spending Accounts/pp• 401(k) Retirement Plan with up to a 6% employer-match/pp• 10+ paid holidays/pp• Generous paid vacation and sick time*/pp• Lots of fun company events/ppbr/ppstrongWho We Are:/strong/ppAs a trusted third-party administrator (TPA) specializing in self-funded benefit plans, Cobalt Benefits Group (CBG) is committed to helping employers find high-quality coverage at a cost they can afford. We administer self-funded insurance benefits through our three companies: EBPA, Blue Benefit Administrators of Massachusetts, and CBA Blue./ppWith over 30 years of experience and a dedicated team of more than 180 employees, we work collaboratively to build customized self-funded health plans, manage claim payments and disputes, and administer other specialized programs such as FSAs, HSAs, COBRA, and retiree billing. Join us as we match employers across our region with the right solutions for their employee benefit needs./ppbr/ppTo learn more about working at CBG, visit Careers | EBPA (ebpabenefits.com)./ppbr/p/div div class="job-listing-header"Salary Description/div div22.00 - 24.00/div /div div class="preview-bottom-apply-btn" a autofocus="true" class="apply-link-marker button apply-button branding-button-color" href="/Recruiting/Jobs/Apply/3531377" onclick="" style="width: 100%;"Apply/a /div div class="vertical-padding" style="text-align: center;" span class="icon-return custom-link-color"/span a href="/Recruiting/Jobs/All/2f4c70ba-44de-4958-af36-0fbada0e1110" onclick="" style="text-decoration: none; color: #0052a1;"View All Jobs/a /div /div footer aside aria-label="Powered by Paylocity Logo and Link" div class="powered-by-paylo" em style="vertical-align: middle"Powered by /emimg style="padding-left:1.5px" src="https://cdn.paylocity.com/cdn/branding/paylocity-logo-left.svg" alt=""br classname="clearfix" a target="_blank" rel="noopener noreferrer nofollow" href="/Recruiting/PrivacyPolicy/List?key=2f4c70ba-44de-4958-af36-0fbada0e1110" style="text-decoration: none" title="Privacy Policy link - will open in new window" Privacy Policy /a a target="_blank" rel="noopener noreferrer nofollow" href="https://www.paylocity.com/" style="text-decoration: none" title="Payroll amp; HR Software link - will open in new window" Payroll amp; HR Software /a /div /aside /footer /div /div /body/html