Working for an insurance company? Anyone do it? Whats it all about?

Flatline, BSN, RN · Dec 19, 2017

My wife works from home for an insurance company.

They hire for all kinds of different positions but specifically, she is a utilization review auditor. She basically reviews the work of other utilization review nurses.

From my limited understanding they instant message each other all day, review charts, and call facilities and offices asking why they didn't chart XYZ. I know case management is a big new push within some of the insurance companies. OK job, pay is about what you make in a hospital except she works banker's hours.

I work in a corporate setting in "industry." I work next to NPs, pharmacists, EMTs, diploma nurses, ADNs, BSNs, MSNs, MBAs, etc. They do things like medical complaints, product development, clinical research, statistical analysis, professional speaking, technical and editorial writing, on and on. Pay is way better than insurance but most positions require you to work in an office although several of my colleagues do work from home.

silverbat · Dec 19, 2017

I do case management for a managed care organization-insurance. I work from home and part of my time is seeing members at their home, the rest is at home on computer. I make mid 30's per hour.

nurse29 · Dec 27, 2017

I work for a large insurance company in their quality department. My job is 100% remote and I'm not required to go into the field. My pay is ok but I chose to take a small pay cut in exchange for the great flexibility and work from home perk. In my position I support small provider practices by helping them improve their "Star Ratings" which are designated by CMS. I've been doing this for about a yr and a half now but before this I worked for a workers comp insurer. This was also work from home but with field visits. Pay was pretty good and the bonuses even better! ... but I got bored after 7 yrs.

iamnotafocker · Dec 27, 2017

Flatline what do you mean by " industry" where do you work?

allnurses Guide · Dec 27, 2017

He/She means they do not wish to share what industry they work in. :)

Flatline, BSN, RN · Dec 27, 2017

Flatline what do you mean by " industry" where do you work?

Pharmaceuticals and medical device manufacturing are often refereed to as "industry."

Madebymelo · Dec 28, 2017

I currently work for an insurance company as a case manager, I've been there about 4 months and honestly I hate it! I get to work from home two days a week and in the office two days a week. In my opinion it's more of a telemarketer job then it is nursing. You call "members" (not patients) but most of them don't know that you're going to be calling them, it's usually based off of claims, and you make sure that they're seeing their doctors regularly and taking their meds. We have a script to follow and you're supposed to make so many calls a day. Not at all what I thought it would be!

Holliernbsn · Dec 28, 2017

I work for a large health insurance company as a high risk OB case manager. My job is 100% remote-work from home and I enjoy it. The pay would be comparable to bedside nursing if not salary. I'm not expected to work OT but when your office is down the hall it's easy to do. Still, I justify the extra hours because I don't have an hour commute each direction so still feels worth it. Also I get my satisfaction from actually feeling I make a difference in these girls lives so I work a lot of OT to give them the time and attention they need. I did bedside nursing for 23 years before taking this role 3 years ago. I'm a single mom down to my last of four kids at home and this girl is busy with club volleyball. The flexibility has allowed me to make every tournament and that makes it worth it to me right now. No holidays or weekends is nice. Will I do this forever? Probably not...I do miss catching babies. I wouldn't recommend this to someone with toddlers unless you hired a nanny as you will be attached to your phone a minimum of 8 hours each day. Yes, you can toss in a load of laundry and start dinner, etc. but having constant interruptions would make this job difficult. Good luck if you decide to look into it.

guest833402 · Aug 20, 2018

I am an RN with a Master's in nursing leadership and management. A few people have recommended working for an insurance company but I am not sure how to get my foot in the door. When I tried to call a few companies they told me to just go online and apply, but I don't know what I am looking for and it seems that all of the positions require previous experience. Can you give me some advice? Feel free to PM me. Thanks!

FDE123 · Oct 9, 2018

What kind of "corporate setting" are you referring to? I am looking to get away from bedside nursing and into something along the line of Utilization Review/Quality but am disturbed by the large pay cut I would be taking.