Utilization Management Coordinator - US Healthcare

Role Overview Shai Global Analytics is hiring a Utilization Management (UM) Coordinator to support its US healthcare operations team based in Kanchipuram. This is a full-time night shift role (9:00 PM to 6:00 AM IST) involving medical data entry, claims processing support, and prior authorization coordination. The ideal candidate brings a solid understanding of US healthcare systems, strong attention to detail, and an unwavering commitment to HIPAA compliance and patient data privacy. Key Responsibilities - Perform accurate data entry for utilization management and medical claims processing tasks - Verify member eligibility and review insurance information through payer portals or telephonic communication - Ensure all healthcare services meet medical necessity criteria and are properly documented in clinical systems - Input clinical and administrative data into healthcare management platforms with completeness and precision - Maintain strict adherence to HIPAA regulations to protect confidentiality, integrity, and security of patient health information - Coordinate prior authorizations, case conferences, and peer-to-peer reviews in collaboration with healthcare providers and Medical Directors - Provide clerical and administrative support including phone inquiries, appointment coordination, and concurrent review tracking - Ensure compliance with Medicaid, Medicare, and Managed Care regulatory standards - Track and report utilization trends and outcomes as part of quality improvement initiatives - Maintain professional work standards and accurate records of all UM-related activities Required Qualifications - Bachelor's degree, preferably in Life Sciences or a related field - Minimum 1 year of experience in US healthcare processes such as Utilization Management, Claims Processing, Eligibility Verification, or Prior Authorization - Strong working knowledge of US healthcare systems including Medicaid, Medicare, Commercial insurance plans, and Managed Care - Basic understanding of medical terminology, anatomy, and physiology - Proficiency in MS Office applications, VOIP systems, and fax-based communication - Excellent verbal and written communication skills with strong analytical ability - Ability to work independently and collaboratively in a fast-paced, compliance-driven environment Why Join Us Shai Global Analytics offers a stable, 365-day operational environment with structured week-offs and a collaborative team culture focused on healthcare excellence. This role provides meaningful exposure to US healthcare workflows and a strong platform for growth within the health IT and managed care domain.

- Minimum 1 year experience in US healthcare (UM, Claims, Eligibility, or Prior Auth) - Bachelor's degree, preferably in Life Sciences - Strong knowledge of Medicaid, Medicare, Commercial plans, and Managed Care - Familiarity with medical terminology, anatomy, and physiology - Proficiency in MS Office, VOIP systems, and faxing - Knowledge of HIPAA compliance and patient data privacy standards - Strong analytical, communication, and problem-solving skills - High attention to detail and accuracy in data entry - Ability to work night shift (9:00 PM to 6:00 AM IST) - Willingness to provide rotational weekend support as per business needs

- Full-time permanent employment - 5-day working week - Staggered week-offs in a 365-day operational setup - Exposure to US healthcare and managed care processes - Collaborative and compliance-focused work environment