Posted Nov 1, 2025

[Remote] UM Coordinator 2 – Amazon Store

November 1, 2025

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Note: The job is a remote job and is open to candidates in USA. Humana Inc. is committed to putting health first for their teammates and customers. The UM Coordinator 2 will contribute to the administration of utilization management by assisting providers with authorization processes and ensuring compliance with guidelines and regulations.

Responsibilities

Responsible for taking inbound calls and assisting providers in determining whether a specific service for a member requires prior authorization or referral, ensuring compliance with established guidelines and processes.
Initiate the authorization process by collecting clinical information and verifying medical necessity, ensuring members are not subjected to unnecessary services or expenses.
Responds to provider inquiries regarding existing authorizations or referrals, and provides timely updates as needed through fax or inbound phone line, ensuring compliance with organizational policies and applicable federal regulations.
Document all call information according to standard operating procedures and attach clinical information when necessary
Support members with authorization requests, including outbound calls to provider offices when required.
Review resources and data to facilitate positive outcomes for consumers, adapting to ongoing changes in processes and procedures due to CMS regulations.
Maintain high-quality standards and meet monthly quality requirements
Ability in maneuvering multiple systems simultaneously

Skills

Minimum 1 year of customer service experience, including the ability to effectively de-escalate challenging situations
After training, you must be available to work any shift between the hours of 6am - 7pm CST and occasional weekends based on business needs
Excellent verbal and written communication skills
Demonstrated attention to detail
Ability to navigate process flows and follow procedure documents
Proficient keyboarding skills for data entry and documentation
Capacity to multitask across various computer systems while engaging with providers or members
Quick aptitude for learning and navigating new technology systems and applications
Proficiency in Microsoft Office applications, including Word and Excel
A designated workspace, with a closed door, that minimizes distractions and meets leadership approval
Must effectively manage personal responsibilities to ensure a professional work environment conducive to achieving performance goals
Proficient utilizing electronic medical record and documentation programs
Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization
Knowledge of Medical Terminology and/or ICD-10 codes
Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization
Bilingual (English & Spanish) fluent in written and verbal communication

Benefits

Health benefits effective day 1
Paid time off, holidays, volunteer time and jury duty pay
Recognition pay
401(k) retirement savings plan with employer match
Tuition assistance
Scholarships for eligible dependents
Parental and caregiver leave
Employee charity matching program
Network Resource Groups (NRGs)
Career development opportunities
Medical, dental and vision benefits
Short-term and long-term disability
Life insurance

Company Overview

Humana is a health insurance provider for individuals, families, and businesses. It was founded in 1964, and is headquartered in Louisville, Kentucky, USA, with a workforce of 10001+ employees. Its website is http://www.humana.com.

Company H1B Sponsorship

Humana has a track record of offering H1B sponsorships, with 202 in 2025, 246 in 2024, 284 in 2023, 274 in 2022, 212 in 2021, 84 in 2020. Please note that this does not guarantee sponsorship for this specific role.

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[Remote] UM Coordinator 2 – Amazon Store

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