Utilization Management Representative


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Full Job Description

Description SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health benefits companies and a Fortune Top 50 Company.

Utilization Management Representative

Due to the current COVID-19 (coronavirus) pandemic, this position will require you to work remotely from your home. As we continue to monitor guidance from CDC and state officials, there may be times you would need to report to the office on a monthly or quarterly basis for team meetings or engagement activities.

Successful candidates for this position will live within a commuting distance from our office in the New York Metro area.

As a Utilization Management Representative you will be responsible for coordinating cases for precertification and prior authorization review.

Primary duties may include, but are not limited to:

Managing incoming calls or faxes authorization requests
Determining contract and benefit eligibility
Reviewing authorization for outpatient and elective inpatient
Enter and create elective inpatient admissions
Referring cases requiring clinical review to a Nurse reviewer
Responsible for the identification and data entry of referral requests into the UM system
Responding to telephone and written inquiries from clients, providers and in-house departments
Developing and maintaining positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner

Here’s what Anthem offers:

A career path with opportunity for growth
Ability to obtain your Associate’s or Bachelor’s degree or further your education with tuition reimbursement.
Affordable Health Insurance, Dental, Vision and Basic Life
401K match, Paid Time Off, Holiday Pay
Quarterly incentive bonus and annual increases plan based on performance.

At Anthem, the team is comprised of the best and the brightest from diverse experiences, cultures, and backgrounds. The differences we each bring to the table are a part of what makes our company so successful.

Qualifications

Required:

High school diploma or GED
Or any combination of education and experience, which would provide an equivalent background.
Ability to work from home with internet access and a quiet and private work space

Preferred:

Medical terminology training
Experience in medical or insurance field
A minimum of 1 year customer service
A minimum of 1 year call-center experience

Soft Skills:

Strong oral, written and interpersonal communication skills
Problem-solving skills
Facilitation skills
Analytical skills.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against Covid-19. All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

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