Referral Specialist I

Elevance Health (Anthem); Chicago (IL); Hybrid; USD 24,000 - 40,000; Full time

Job summary

Elevance Health is seeking a Referral Specialist I in the United States (Illinois/Virginia) for a hybrid/virtual role with occasional in-office training sessions. You will support a clinical team by managing referrals, pre-authorization, and coordination with hospitals, physicians, and patients.

Shifts run between 7 AM and 8 PM Central time, with in-person requirements as needed. Minimum requirements include a HS diploma or GED and 1 year of experience in a high-volume patient/customer service

Qualifications

• Requires HS diploma or GED and at least 1 year of experience in a high-volume, interactive customer service or call center environment.
• Knowledge of medical terminology strongly preferred.
• Experience in healthcare industry preferred.

Responsibilities

• Initiates and manages clinical referrals for pre-authorization.
• Acts as a liaison between hospital, health plans, physicians, patients, vendors and other referral sources.
• Reviews referrals for completeness and follows up for additional information if necessary.
• Assigns escalated referrals to staff as appropriate.
• Verifies insurance coverage and completes pre-authorization process for radiology and other imaging exams (CT, MRI, MRA, PET, et.) following established process and procedures.
• Responds to inbound calls initiating exam requests following established processes, meets quality and production standards.
• Contacts physician offices as needed to obtain demographic information or related data.
• Enter(s) referrals, documents communications and actions in system.

Skills

Customer service

Medical terminology

Call center experience

Education

HS diploma or GED

Job description

Referral Specialist I

Location: This role enables associates to work virtually full‑time, except for required in‑person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work‑life integration, and ensures essential face‑to‑face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Hours: Monday through Friday; candidates will be assigned a shift between 7 AM and 8 PM Central time.

The Referral Specialist I is responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals.

How you will make an impact

• Initiates and manages clinical referrals for pre‑authorization.
• Acts as a liaison between hospital, health plans, physicians, patients, vendors and other referral sources.
• Reviews referrals for completeness and follows up for additional information if necessary.
• Assigns escalated referrals to staff as appropriate.
• Verifies insurance coverage and completes pre‑authorization process for radiology and other imaging exams (CT, MRI, MRA, PET, et.) following established process and procedures.
• Responds to inbound calls initiating exam requests following established processes, meets quality and production standards.
• Contacts physician offices as needed to obtain demographic information or related data.
• Enter(s) referrals, documents communications and actions in system.
• Associates in this role are expected to have the ability to multi‑task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.
• Additional expectations to include but not limited to: Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast‑paced, high‑pressure environment; strong verbal and written communication skills, both with virtual and in‑person interactions; attentive to details, critical thinker, and a problem‑solver; demonstrates empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.
• Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.
• Performs other duties as assigned.

Minimum Requirements

• Requires HS diploma or GED and a minimum of 1 year of experience in a high‑volume, interactive customer service or call center environment; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences

• Knowledge of medical terminology strongly preferred.
• Experience in healthcare industry preferred
• Inbound call center experience preferred

Locations

• Illinois
• Virginia

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $17.42 - $28.75/hr

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non‑discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Job Level: Non‑Management Non‑Exempt

Job Family: CUS > Care Support