Remote Utilization Management Services Rep I

Excellus BCBS; City of Utica (NY); Remote; USD 28,000 - 37,000; Full time

Benefits offered by this job

Remote work possible

Job summary

Excellus BCBS is seeking an UM Services Representative to support Utilization Management workflows with administrative and customer service duties. You will handle inbound/outbound calls, process authorizations via phone, fax, and provider tools, and ensure timely, accurate responses for procedures across inpatient, outpatient, behavioral health, and durable medical equipment.

The role requires strong communication, analytical skills, and the ability to work in a collaborative, regulated

Qualifications

• High School Diploma or GED.
• Experience with using a desktop computer in a professional environment, preferably with Microsoft Office Products.
• Call center experience preferred, not required.
• Strong analytical and problem-solving skills.
• Strong written and verbal communication skills and ability to work within a team.
• Demonstrated organizational skills to manage multiple projects and priorities.
• Self-motivated and able to work independently, as well as on intra- and inter-departmental teams where needed.

Responsibilities

• Handle inbound and outbound calls delivering customer-centered service to members and providers.
• Provide information on services and regulations in a call center setting.
• Process authorizations via phone, Care Advance Provider Tool, and fax.
• Assist with triage for UM services and respond to research inquiries.
• Support compliance with DOH/NCQA requirements and privacy policies.

Skills

Communication skills

Analytical skills

Problem solving

Organizational skills

Teamwork

Self-motivation

Education

High School Diploma or GED

Tools

FACETS

PEGA

Job description

Excellus BCBS is seeking an UM Services Representative to support Utilization Management workflows with administrative and customer service duties. You will handle inbound/outbound calls, process authorizations via phone, fax, and provider tools, and ensure timely, accurate responses for procedures across inpatient, outpatient, behavioral health, and durable medical equipment.

The role requires strong communication, analytical skills, and the ability to work in a collaborative, regulated