Utilization Management Representative I-2

Jobtailor; Indianapolis (IN); On-site; USD 34,000 - 48,000; Full time

Job summary

Jobtailor in Indianapolis, IN is seeking a detail-oriented coordinator to manage precertification and prior authorization reviews. You will handle incoming calls and post-service claims, determine eligibility, and authorize initial provider sessions within UM workflows.

The role emphasizes strong communication, multitasking, and a patient-focused approach in a fast-paced environment. Office-based with potential overtime supports essential coverage.

Qualifications

• HS diploma or GED.
• Minimum of 1 year of customer service or call-center experience.
• Medical terminology training and experience in medical or insurance field preferred.
• Strong oral, written and interpersonal communication skills.
• Problem-solving skills.
• Facilitation skills.
• Analytical skills.
• Ability to multi-task while handling calls, texts, facsimiles, and electronic queues.
• Proficiency with digital tools and platforms.
• Ability to work a structured schedule with occasional overtime or flexibility based on business needs.
• Ability to work from the office as necessary.

Responsibilities

• Coordinate cases for precertification and prior authorization review.
• Manage incoming calls or incoming post services claims work.
• Determine contract and benefit eligibility.
• Provide authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
• Refer cases requiring clinical review to a Nurse reviewer.
• Identify and enter referral requests into the UM system in accordance with the plan certificate.
• Respond to telephone and written inquiries from clients, providers, and in-house departments.
• Conduct the clinical screening process.
• Authorize initial sets of sessions to providers.
• Check benefits for facility-based treatment.
• Develop and maintain positive customer relations.
• Coordinate with various company functions to handle customer requests and questions appropriately and promptly.
• Handle calls, texts, facsimiles, and electronic queues while taking notes and speaking to customers.
• Perform other duties as assigned.

Skills

Customer service

Medical terminology

Communication skills

Problem solving

Multitasking

Digital tools

Education

HS Diploma or GED

Tools

UM System

Electronic queues

Job description

• Coordinate cases for precertification and prior authorization review
• Manage incoming calls or incoming post services claims work
• Determine contract and benefit eligibility
• Provide authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
• Refer cases requiring clinical review to a Nurse reviewer
• Identify and enter referral requests into the UM system in accordance with the plan certificate
• Respond to telephone and written inquiries from clients, providers, and in-house departments
• Conduct the clinical screening process
• Authorize initial sets of sessions to providers
• Check benefits for facility-based treatment
• Develop and maintain positive customer relations
• Coordinate with various company functions to handle customer requests and questions appropriately and promptly
• Handle calls, texts, facsimiles, and electronic queues while taking notes and speaking to customers
• Perform other duties as assigned

Requirements

• 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
• Strong oral, written and interpersonal communication skills
• Problem-solving skills
• Facilitation skills
• Analytical skills
• Ability to multi-task while handling calls, texts, facsimiles, and electronic queues
• Proficiency with digital tools and platforms
• Ability to maintain focus during extended periods of sitting and handle multiple tasks in a fast-paced, high-pressure environment
• Ability to work a structured schedule with occasional overtime or flexibility based on business needs
• Ability to work from the office as necessary
• For certain patient/member-facing roles, vaccination against COVID-19 and Influenza is required unless an acceptable explanation is provided
• Must live within a 30–40 mile proximity to an office in Indianapolis, IN or Midland, GA, or within commuting distance from an office

Core Competencies

Demonstrates expertise in precertification and prior authorization processes, with strong communication and problem-solving skills to effectively manage customer inquiries and coordinate with various departments. Proficient in handling multiple tasks in a fast-paced environment while maintaining positive customer relations.

Highest-signal resume keywords

• Precertification Coordination
• Customer Service Experience
• Medical Terminology Knowledge
• Analytical Skills
• Digital Tools Proficiency

Hard Skills

• Precertification
• Prior Authorization
• Medical Terminology
• Analytical Skills
• Problem-Solving Skills

Soft Skills

• Interpersonal Communication
• Facilitation Skills
• Multi-Tasking Ability

Certifications & Qualifications

• HS Diploma
• GED

Industry Keywords

• Insurance Field
• Customer Relations
• Clinical Review
• Inpatient Admission
• Outpatient Precertification

Tools & Technologies

• UM System
• Digital Tools
• Electronic Queues