Medicaid Claims Administration Coordinator – UM, UR, PA

Humana

UM Administration Coordinator contributing to utilization management for Humana's KY Medicaid plan. Performing varied administrative tasks and providing non-clinical support for members' treatment.

Posted 7/31/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $40,000 - $52,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Utilization Review and Prior Authorization processes within managed care, alongside a strong foundation in medical claims and Medicaid operations. Proficient in administrative support and customer service within healthcare settings, ensuring compliance with policies and quality standards.

Highest-signal resume keywords

Utilization Review (UR)Prior Authorization (PA)Medical Claims ProcessingMedicaid ExperienceElectronic Medical Record Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ReviewPrior AuthorizationMedical ClaimsICD-10 CodesAdministrative SupportCustomer ServiceMS OfficeWindows-Based EnvironmentElectronic Medical Record SystemsMedical Terminology

Soft Skills

Interpretation of PoliciesIndependent Decision-MakingAttention to DetailCommunication SkillsProblem-Solving

Industry Keywords

Managed CareHealthcareInsuranceUtilization ManagementMember Services

About the role

Key responsibilities & impact

contributes to administration of utilization management for Humana's KY Medicaid plan
performs varied activities and moderately complex administrative/operational/customer support assignments
provides non-clinical support for the procedures ensuring best treatment, care or services for members
decisions are typically focus on interpretation of area/department policy and methods for completing assignments
work within defined parameters to identify work expectations and quality standards
follow standard policies that allow for some opportunity for interpretation/deviation and independent

Requirements

What you’ll need

2+ years of experience in medical claims
1+ years of Medicaid experience
2+ years of experience with Utilization Review (UR) and/or Prior Authorization (PA) processes within a managed care organization
2+ years of administrative experience or experience in a similar healthcare, insurance, or managed care role
Working knowledge of MS Office including Word, Excel, and Outlook in a Windows-based environment and an ability to quickly learn new systems
Proficient using electronic medical record and documentation programs
Proficient or experience with medical terminology or ICD-10 codes
Prior member service or customer service telephone experience

Benefits

Comp & perks

medical, dental and vision benefits
401(k) retirement savings plan
time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
short-term and long-term disability
life insurance
many other opportunities