Utilization Management Support Specialist I

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

Benefits offered by this job

Remote work option

Job summary

Excellus BCBS is seeking a detailed UM Support position in New York state to assist with utilization management workflows. The role involves handling inbound and outbound calls, authorizing services by phone or fax, and supporting both members and providers across inpatient and outpatient procedures, behavioral health, and equipment.

Level I–III responsibilities include triage, provider contact, regulatory notifications, and cross-department collaboration to ensure end-to-end authorization

Qualifications

• High School Diploma or GED.
• Experience with using a desktop computer, preferably with Microsoft Office.
• Call center experience preferred, not required.
• Strong analytical and problem-solving skills.
• Strong written and verbal communication skills and ability to work in 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.

Responsibilities

• Facilitates inbound and outbound calls to customers (members and providers).
• Responds to customers professionally to promote services and policies.
• Perform triage for UM Services.
• Serve as primary contact for providers regarding authorizations.
• Notify members/providers about regulatory requirements (DOH, NCQA).
• Provide timely responses to inquiries; ensure accuracy and regulatory timeframes.
• Process fax requests from designated queues.
• Maintain privacy and integrity aligned with company policies.
• Attend obligations and assist with additional tasks as assigned.

Skills

Customer service

Communication skills

Analytical thinking

Team collaboration

Time management

Self-motivation

Education

High School Diploma or GED

Tools

Microsoft Office

Job description

Excellus BCBS is seeking a detailed UM Support position in New York state to assist with utilization management workflows. The role involves handling inbound and outbound calls, authorizing services by phone or fax, and supporting both members and providers across inpatient and outpatient procedures, behavioral health, and equipment.

Level I–III responsibilities include triage, provider contact, regulatory notifications, and cross-department collaboration to ensure end-to-end authorization