This role is for someone who can be calm, sharp, and human when people are stressed about their healthcare. You’ll guide members through appeals, external medical reviews, and fair hearings, and you’ll keep the process compliant, documented, and moving.
About BroadPath
BroadPath supports health plans with skilled remote teams across member services, utilization management, and operations. They’re built for work-from-home roles that still feel mission-driven, with a strong focus on service, quality, and outcomes.
Schedule
Training: 2 weeks, Monday–Friday, 8:00 AM–5:00 PM CST
Production: Monday–Friday, 8:00 AM–5:00 PM CST (no weekends)
What You’ll Do
• Serve as the first point of contact for members navigating appeals, external medical review, and fair hearing processes
• Educate members on their rights and responsibilities and clearly explain next steps in the resolution journey
• Act as a member advocate, gathering required documentation and supporting proper representation
• Monitor queues and adherence to meet service levels and manage escalations in real time
• Partner with internal teams (Claims, Eligibility, Provider Relations, Operations, and more) to resolve issues
• Translate communications and documents between English and Spanish and interpret for Spanish-speaking members, applying cultural and medical interpretation skills
• Initiate and manage External Medical Review and State Fair Hearing workflows using the HHSC Intake Portal (TIERS)
• Track compliance, timelines, and documentation requirements, and submit materials within mandated timeframes
• Enter EMR and Fair Hearing data accurately into the Utilization Management system and support reporting needs
• Support Utilization Management administration, including collecting member/provider info and applying knowledge of medical terminology and codes (ICD-10, CPT, HCPCS)
• Contribute to quality initiatives, process improvements, and internal projects
What You Need
• High school diploma or equivalent
• 4+ years of foundational Utilization Management experience
• Understanding of health plan operations, claims/eligibility systems, claims processing, and benefits
• Familiarity with Texas Department of Insurance and HHSC rules for complaints and appeals
• Experience with managed care, Medicaid programs, call center tools, and strong customer service practices
• Strong phone presence, active listening, problem solving, multitasking, and high attention to detail
• Medical terminology knowledge
Preferred
• 2+ years direct experience with UM Prior Authorizations, Appeals, Fair Hearings, and External Medical Review
• Community Health Worker (CHW) certification (Texas DSHS)
• Background in benefits, claims processing, or membership
Benefits
• Up to $22/hour base pay (weekly pay)
• Stable weekday schedule with no weekends
• Inclusive, equal opportunity employer culture
• Accommodation support available through HR (upon request)
If you’ve got UM chops and you’re bilingual, this role can be a real sweet spot: structured hours, clear processes, and work that actually matters.
Happy Hunting,
~Two Chicks…