Backoffice Utilization Specialist I

Elevance Health; North Carolina; Hybrid; USD 22,000 - 33,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

Elevance Health seeks an Utilization Management Representative I for backoffice support. This role processes precertification, prior authorization, and post-service requests with minimal inbound calls and some outbound information gathering.

It emphasizes accuracy, confidentiality, and adherence to HIPAA rules. Hybrid/remote work is offered with in-person training sessions as required, and a schedule aligned to Eastern Time business needs.

Qualifications

• Requires a high school diploma or GED with 1+ year of customer service or call-center experience.
• Experience with healthcare operations, data entry, and back-office tasks is preferred.
• HIPAA privacy and security awareness is expected or desirable.

Responsibilities

• Process precertification, prior authorization, and post-service requests.
• Enter referrals and authorizations accurately into systems.
• Prepare clear fax communications to providers, members, and internal partners.
• Meet productivity and quality standards with low error rates.
• Maintain confidentiality and comply with HIPAA regulations.

Skills

Customer service

Data entry

Medical terminology

HIPAA knowledge

Education

HS diploma or GED

Tools

Document-management systems

Electronic health records

Job description

Elevance Health seeks an Utilization Management Representative I for backoffice support. This role processes precertification, prior authorization, and post-service requests with minimal inbound calls and some outbound information gathering.

It emphasizes accuracy, confidentiality, and adherence to HIPAA rules. Hybrid/remote work is offered with in-person training sessions as required, and a schedule aligned to Eastern Time business needs.