Anthem, Inc. Utilization Management Rep I in Charleston, West 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 care companies and a Fortune Top 50 Company.
Responsible for coordinating cases for precertification and prior authorization review. Primary duties may include, but are not limited to:
• Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests. • Refers 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. • Responds to telephone and written inquiries from clients, providers and in-house departments. • Conducts clinical screening process. • Authorizes initial set of sessions to provider. • Checks benefits for facility-based treatment. • Develops and maintains 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.
Must be available to work a flexible schedule between the hours of 4:00PM – 7:00AM CST to include weekends and holidays (day or night)
• Requires a High School diploma/GED. • 1 year of customer service or call-center experience; proficient analytical, written and oral communication skills; or any combination of education and experience, which would provide an equivalent background. • Medical terminology training and experience in medical or insurance field preferred. • Experience with diagnosis codes and current procedural terminology (CPT) codes, an added plus. • Experience working overnights would be an added plus. • Proficient with Microsoft Office Suite/MS Teams. • For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving, 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. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 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.