Anthem, Inc. Utilization Management Representative I in Virginia Beach, Virginia
SHIFT: Day Job
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 Representatives are responsible for coordinating cases for precertification and prior authorization review. On this team, you will spend a large part of your day identifying appropriate health care providers for members based on requests from case managers or other team members within the preauthorization guidelines.
Location: This is a 100% remote position; successful candidates will be located in Virginia, Missouri, Georgia, Arkansas, Tennessee or Kentucky. Successful candidates will meet Anthem Work at Home requirements including hard-wired high speed internet and a private secure workspace.
Training will be for 6 weeks, Monday - Friday, from 8:00 am - 5:00 pm or 9:00 - 6:00 pm EST . The regular shift will vary based on needs of business, the shifts are: 9:30 am - 6:00 pm or 11:30 am - 8:00 pm EST.
Primary duties may include, but are not limited to:
Managing incoming calls or incoming post services claims work.
Determining contract and benefit eligibility; providing authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
Referring cases requiring clinical review to a Nurse reviewer.
Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
Responding to telephone and written inquiries from clients, providers and in-house departments.
Conducting clinical screening process.
Authorizing initial set of sessions to provider.
Checking benefits for facility based treatment.
Developing and maintaining positive customer relations and coordinating with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
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.
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.
Ability to work from home with internet access and a quiet and private work space.
Medical terminology training
Experience in medical or insurance field
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. 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. 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. Anthem is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.