Remote Utilization Management Rep I

Elevance Health; Columbus (GA); Hybrid; USD 42,000 - 54,000; Full time

Benefits offered by this job

Paid holidays

Paid Time Off

Medical benefits

Dental benefits

Vision benefits

401(k) + match

Job summary

Elevance Health is seeking an Utilization Management Representative I to coordinate precertification and prior authorization reviews. The role offers hybrid work with occasional in-person training and requires flexibility for weekends and overtime, with onboarding sessions, time-zone considerations, and policy-driven remote eligibility.

Responsibilities include handling calls and claims, verifying benefits, and entering referral data while maintaining strong customer relations and multi-tasking

Qualifications

• Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.
• Inbound call center experience strongly preferred.
• Medical terminology training and experience in medical or insurance field strongly preferred.

Responsibilities

• Managing incoming calls or incoming post services claims work.
• Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
• Refers cases requiring clinical review to a Nurse reviewer.
• Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
• Responds to telephone and written inquiries from clients, providers and in-house departments.
• Conducts clinical screening process.
• Authorizes initial set of sessions to provider.
• Checks benefits for facility based treatment.
• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
• 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.

Skills

Customer service

Call center experience

Medical terminology training

Education

HS diploma or GED

Job description

Elevance Health is seeking an Utilization Management Representative I to coordinate precertification and prior authorization reviews. The role offers hybrid work with occasional in-person training and requires flexibility for weekends and overtime, with onboarding sessions, time-zone considerations, and policy-driven remote eligibility.

Responsibilities include handling calls and claims, verifying benefits, and entering referral data while maintaining strong customer relations and multi-tasking