Remote Utilization Management Rep I

Anthem Blue Cross & Blue Shield; Columbus (GA); Remote; USD 23,000 - 29,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative I for a fully virtual role with occasional in-person training. You will coordinate precertification and prior authorization reviews, manage calls and inquiries, and reference plan certificates to determine eligibility and approvals.

The role requires strong communication skills, attention to detail, and the ability to multi-task in a fast-paced environment.

Qualifications

• HS diploma or GED.
• Minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.
• Medical terminology training and experience in medical or insurance field preferred.
• URAC competencies: strong oral, written and interpersonal communication skills, problem-solving, facilitation, and analytical skills.

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.
• Responds to telephone and written inquiries from clients, providers and in-house departments.
• 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.

Skills

Customer service

Communication skills

Medical terminology

Education

HS diploma or GED

Job description

Elevance Health is seeking an Utilization Management Representative I for a fully virtual role with occasional in-person training. You will coordinate precertification and prior authorization reviews, manage calls and inquiries, and reference plan certificates to determine eligibility and approvals.

The role requires strong communication skills, attention to detail, and the ability to multi-task in a fast-paced environment.