Remote Utilization Management Representative I

Elevance Health (Anthem); Boght Corners (NY); Hybrid; USD 23,000 - 38,000; Full time

Job summary

Elevance Health is seeking a Utilization Management Representative I (US) to coordinate precertification and prior authorization reviews. This role supports virtual work with required in-person training, offering flexibility and autonomy.

It involves handling calls, processing claims, and determining eligibility in a fast-paced environment. Responsibilities include advising on benefits, authorizing initial provider sessions, routing cases for clinical review, and maintaining strong client

Qualifications

• HS diploma or GED required.
• 1 year of customer service or call-center experience preferred.

Responsibilities

• Coordinate cases for precertification and prior authorization review.
• Manage incoming calls and process claims work.
• Determine contract and benefit eligibility and authorize initial set of sessions as needed.
• Refer cases to a Nurse reviewer for clinical review.
• Check benefits for facility-based treatment and respond to inquiries from clients and providers.
• Maintain positive customer relations and multi-task in a fast-paced environment.

Skills

Customer service

Communication

Call-center experience

Medical terminology

Education

HS diploma or GED

Job description

Elevance Health is seeking a Utilization Management Representative I (US) to coordinate precertification and prior authorization reviews. This role supports virtual work with required in-person training, offering flexibility and autonomy.

It involves handling calls, processing claims, and determining eligibility in a fast-paced environment. Responsibilities include advising on benefits, authorizing initial provider sessions, routing cases for clinical review, and maintaining strong client