Utilization Management Support Specialist I (Remote Potential)

Capital District Physicians Health Plan Inc; City of Binghamton (NY); Hybrid; USD 28,000 - 37,000; Full time

Benefits offered by this job

Remote work option

Job summary

Capital District Physicians Health Plan Inc. seeks an organized, customer-focused UM support specialist to handle inbound/outbound calls, process authorizations, and assist providers and members in a compliant manner.

The role involves triage of UM services, coordination across departments, and providing timely responses to inquiries while maintaining member privacy and meeting regulatory timeframes.

Qualifications

• High School Diploma or GED required or equivalent experience.
• Proficiency with desktop computing and Microsoft Office products.
• Call center experience preferred but not required.
• Strong analytical and problem-solving abilities; excellent communication and teamwork.

Responsibilities

• Handle inbound/outbound calls from members and providers with professional, customer-centered service.
• Assist with authorizations via phone, Care Advance Provider Tool, and fax for procedures and equipment.
• Triage UM services and serve as primary contact for providers on authorization requests.
• Coordinate regulatory notifications and QA research inquiries; ensure timely responses.
• Support end-to-end authorization processes with other departments for accuracy.
• Maintain privacy and compliance with corporate policies; attend to multiple priorities.

Skills

Customer service

Call center experience

MS Office proficiency

Analytical skills

Verbal communication

Written communication

Organizational skills

Self-motivation

Education

High School Diploma or GED

Tools

Care Advance Provider Tool

FACETS

PEGA

Job description

Capital District Physicians Health Plan Inc. seeks an organized, customer-focused UM support specialist to handle inbound/outbound calls, process authorizations, and assist providers and members in a compliant manner.

The role involves triage of UM services, coordination across departments, and providing timely responses to inquiries while maintaining member privacy and meeting regulatory timeframes.