Utilization Management Representative I, II - Job Family

Description

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. 

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

This position can be filled at Utilization Management Representative I or II level. The hiring manager will determine the level, based on the candidate’s experience and background.  
 

Required:

• UMRI  -  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.
• UMRII  - Requires HS diploma or equivalent and a minimum of 2 years customer service experience in healthcare related setting and medical terminology training; or any combination of education and experience which would provide an equivalent background. Certain contracts require a Master's degree.

Preferred:

• UMRI - Medical terminology training and experience in medical or insurance field preferred.
• Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and 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.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes.  To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. 

Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.