Remote Utilization Management Rep II Preauth & Eligibility

Elevance Health (Anthem); City of Pewaukee (WI); Hybrid; USD 48,000 - 64,000; Full time

Benefits offered by this job

Merit increases

Paid holidays

Paid Time Off

Medical, dental, vision

401(k) + match

Stock purchase plan

Life insurance

Wellness programs

Job summary

Elevance Health, a Fortune 25 health company, seeks a Utilization Management Rep II in Wisconsin. The role supports authorization, eligibility determinations, and referrals with hybrid/virtual flexibility and essential in-person training.

Candidates should have a HS diploma and 2+ years in healthcare customer service; strong communication and analytical skills are required. Onsite collaboration at the Waukesha, WI office is expected.

Qualifications

• Requires HS diploma or equivalent and 2 years of customer service experience in a healthcare setting, plus medical terminology training.
• Strong oral and written communication skills, attention to detail, and ability to handle sensitive information.

Responsibilities

• Manage incoming calls and post services claims work.
• Determine contract and benefit eligibility; authorize inpatient admissions, precertification, prior authorization, and post-service requests.
• Obtain demographic information from callers.
• Conduct radius search in Provider Finder and follow up with providers on referrals.
• Refer cases for clinical review to a nurse reviewer; handle referrals for specialty care.
• Process requests and collect information for review to screen precertification/prior authorization.
• Verify benefits and eligibility information.
• Act as liaison between Medical Management and internal departments.
• Respond to inquiries from clients, providers and internal teams.
• Conduct clinical screening process.

Skills

Customer service

Medical terminology

Communication skills

Problem solving

Education

High School Diploma

Job description

Elevance Health, a Fortune 25 health company, seeks a Utilization Management Rep II in Wisconsin. The role supports authorization, eligibility determinations, and referrals with hybrid/virtual flexibility and essential in-person training.

Candidates should have a HS diploma and 2+ years in healthcare customer service; strong communication and analytical skills are required. Onsite collaboration at the Waukesha, WI office is expected.