Remote Utilization Management Rep I

Excellus BlueCross BlueShield; City of Utica (NY); On-site; USD 28,000 - 37,000; Full time

Job summary

Excellus BlueCross BlueShield is seeking a Level I UM Administrative Support representative to handle inbound/outbound calls, authorization creation by phone, and fax for inpatient/outpatient procedures, behavioral health, and durable medical equipment. You will triage UM services, assist providers with authorization requests, and ensure privacy per corporate policies.

The role requires strong communication, organization, and problem-solving skills, with experience in a medical or managed care

Qualifications

• High School Diploma or GED required.
• Experience with desktop computers in a professional environment; Microsoft Office products preferred.
• Call center experience is a plus.
• Strong analytical and problem-solving skills.
• Strong written and verbal communication; ability to work in a team.
• Excellent organizational skills to manage multiple projects and priorities.
• Self-motivated with ability to work independently and with teams.

Responsibilities

• Facilitate inbound and outbound calls delivering customer-centered service.
• Respond professionally to encourage understanding of products and policies.
• Perform triage for UM Services and act as primary contact for provider authorizations.
• Communicate regulatory requirements (DOH, NCQA) to members/providers.
• Provide timely responses to research inquiries and ensure regulatory timeframes.
• Process fax requests from designated queues.
• Maintain member privacy per corporate policies.
• Attend to Level II/III tasks including project support, coaching, and cross-department collaboration.

Skills

Analytical skills

Communication skills

Organizational skills

Self-motivation

Call center experience

MS Office

Team collaboration

Mentoring

Multi-program navigation

Problem solving

Managed care exposure

Health plan knowledge

FACETS familiarity

Contracts knowledge

Education

High School Diploma or GED

Job description

Excellus BlueCross BlueShield is seeking a Level I UM Administrative Support representative to handle inbound/outbound calls, authorization creation by phone, and fax for inpatient/outpatient procedures, behavioral health, and durable medical equipment. You will triage UM services, assist providers with authorization requests, and ensure privacy per corporate policies.

The role requires strong communication, organization, and problem-solving skills, with experience in a medical or managed care