Utilization Review Technician

Blue Cross Blue Shield of North Dakota•Fargo, ND

8d•$22 - $29•Hybrid

About The Position

The Utilization Review Technician is responsible for providing support for care coordination, network, referrals, and other pre- and post-service requests by receiving, reviewing, and acting on requests from service providers for medical procedures, treatments, and medications.

Requirements

Associate's degree in health care administration, business, general studies or related field is required
3 years in medical office-setting, health insurance, or related experience is required
Demonstrated ability to communicate clearly and effectively in both verbal and written formats
Foundational technical and professional knowledge with the ability to learn and apply new concepts
Strong collaboration skills with the ability to work effectively across teams
Sound basic decision‑making skills with the ability to identify appropriate next steps
Proven ability to engage professionally and effectively with customers
Exceptional attention to detail and a high degree of accuracy in all work
Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

Nice To Haves

Bachelor's degree is strongly preferred
Knowledge of health insurance and medical terminology, coding, healthcare, insurance, claims processing or related experience is preferred

Responsibilities

Receives and reviews incoming preservice requests from services providers and prioritizes workload to ensure timeliness standards and inventory reviews are maintained.
Responds and resolves requests within scope of practice following standard communications protocols. Refers cases to appropriate nursing staff for further review if necessary.
Acts as a resource to internal and external customers for non-medical aspects of utilization management review.
Researches and provides both written and/or oral communication to internal and external customers and providers in a professional manner.
Provides support by performing benefit analysis, data analysis, interpretation of suspensions, and entering information into multiple systems with accuracy and maintaining reference documents as appropriate.
Completes daily claims inventory, collects, and prepares data/reports with accuracy and in a timely manner to appropriate staff members.
Answers questions and responds to a variety of inquiries, provides information requiring working knowledge of policies and procedures, and resolves questions or problems relating to assigned area.

Benefits

Affordable medical, dental and vision coverage accepted throughout the United States
Employer funded Lifestyle Spending Accounts and Health Savings Accounts. Voluntary employee contributions to Health Savings Accounts and Flexible Spending Accounts
Employer-paid life and disability insurance
401(k) retirement plan with company match and immediate vesting
Paid holidays, paid time off (PTO), PTO donation program, and paid parental leave
Voluntary benefits including Accident, Hospital Indemnity, Critical Illness, Term/Whole Life, Cancer Care Insurance, and more.
Robust mental health offerings including an Employee Assistance Program, Learn to Live, meQ.
Comprehensive learning and development opportunities and an Educational Assistance Program.
16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
Employee recognition, community initiative events and yearly company outings.
Workplace flexibility offering different options for working arrangements and the freedom to make time for important commitments.
Opportunities to connect through employee committees.