Lawsuit Claims Highmark Owes Utilization Review Workers Unpaid Overtime

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Highmark, Inc. faces a proposed class and collective action over the company’s alleged failure to pay proper overtime wages to utilization review nurses and workers in similar positions.

According to the lawsuit, the defendant’s apparent policy of misclassifying certain employees—namely utilization management nurses, utilization review nurses, care coordinators, nurse reviewers, care management nurses and others whose primary jobs were to perform utilization review work—as overtime-exempt is to blame for the unpaid time-and-a-half wages.

The plaintiff, who worked for Highmark as a care management nurse from June 2017 to September 2019, argues she and similarly situated workers were entitled to overtime pay given the nature of their job duties yet were willfully denied time-and-a-half wages by the defendant.

“At all times relevant herein, Defendant operated a willful scheme to deprive Plaintiff and others similarly situated of overtime compensation,” the complaint claims.

Highmark, who’s among the 10 largest health insurers in the U.S. and is the fourth-largest company affiliated with Blue Cross and Blue Shield, operates health insurance plans in Pennsylvania, Delaware and West Virginia that provide 5.2 million members with dental insurance, vision care and “other related health businesses,” the lawsuit relays. Per the case, the plaintiff and similarly situated employees primarily performed non-exempt work that included reviewing medical authorization requests submitted by healthcare providers and determining whether they meet specified guidelines for coverage and payment purposes. The workers were paid a salary and classified as exempt from receiving overtime pay, according to the suit.

The case alleges that Highmark “has been aware, or should have been aware,” that utilization review workers performed non-exempt tasks for which they should have been paid overtime wages yet required them to work long hours to meet productivity standards without paying overtime.

The plaintiff claims that when she questioned her supervisor about the defendant’s nonpayment of overtime wages, she was told that “it was part of the job and that she needed to work as much as was required to get the work done” because she worked in a salaried position.

The lawsuit further claims Highmark failed to keep or preserve records of employees’ hours “[a]lthough it had a legal obligation to do so.”

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