Remote Utilization Management Specialist I - Backoffice

Anthem Blue Cross & Blue Shield; Columbus (GA); Hybrid; USD 38,000 - 52,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative I – Backoffice Support. This hybrid role allows virtual work with required in-person training sessions and occasional office visits; shift options run 8:00 a.m. – 8:00 p.m.

ET. Responsibilities include processing precertification, prior authorization, and post-service requests for governmental and commercial lines in a back-office setting. Minimum qualifications include a HS diploma or GED and 1 year of customer service

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.
• Experience with data entry, document processing, or back-office operations preferred

Responsibilities

• Reviews and processes utilization management requests received through fax, electronic queues, and other approved channels.
• Accurately enters referral and authorization information into utilization management systems.
• Prepares and sends clear, complete, and accurate fax correspondence to providers, facilities, members, and internal partners.
• Meets departmental productivity, quality, accuracy, and turnaround‑time standards while maintaining a low error rate.
• Reviews documentation for completeness and refers cases requiring clinical review to the appropriate clinical reviewer.
• Verifies benefits and administrative requirements within the scope of the role.
• Documents all actions and correspondence accurately and completely.
• Demonstrates accountability and ownership of assigned workload by monitoring queues, prioritizing tasks, following work through completion, and escalating barriers promptly.
• Protects confidential information and complies with HIPAA, privacy and security requirements, company policies, accreditation standards, contractual obligations, and applicable federal and state regulations.
• Identifies and reports potential quality, privacy, compliance, or regulatory concerns through established escalation processes.
• Performs other duties as assigned.

Skills

Administrative support

Healthcare operations

Data entry

Document processing

Back-office experience

Medical terminology

URAC competencies

Oral communication

Written communication

Interpersonal communication

Problem solving

Facilitation

Analytical skills

High-volume environment

Privacy requirements

Education

HS diploma or GED

Job description

Elevance Health is seeking an Utilization Management Representative I – Backoffice Support. This hybrid role allows virtual work with required in-person training sessions and occasional office visits; shift options run 8:00 a.m. – 8:00 p.m.

ET. Responsibilities include processing precertification, prior authorization, and post-service requests for governmental and commercial lines in a back-office setting. Minimum qualifications include a HS diploma or GED and 1 year of customer service