Anthem, Inc. Referral Specialist I in Houston, Texas
SHIFT: Day Job
Be part of an extraordinary team
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
AIM Specialty Health is a benefit-management leader in Illinois and a proud member of Anthem's family of companies. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology.
The Referral Specialist I is responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals for various AIM services.
Primary duties may include, but are not limited to:
Validating appeal requests
Managing emails and voicemails as assigned
Opening and closing appeal requests following established appeal processes to maintain quality, turnaround time, and compliance requirements.
Outreach to providers with appeal process instructions
Notifying providers of appeal decisions
Maintain personal log all appeal requests assigned to ensure completion, as needed.
Schedule: Must be able to work 9:30 AM to 6 PM PST / 11:30 AM to 8 PM CST and have flexibility to work weekends.
Internet Requirement: Minimum download speed of 20 megabytes per second (mbps) / upload speed of 5 megabytes per second (mbps)
Requires HS diploma or GED
Minimum of 1 year of experience in a high-volume, interactive customer service or call center environment
Any combination of education and experience which would provide an equivalent background.
Experience working with MS Excel, MS Outlook, and MS PowerPoint
Must have an average typing speed of 45+ WPM
Knowledge of medical terminology preferred.
Solid typing skills and familiarity with computer systems
Able to navigate technology/multiple platforms and applications
Ability to communicate professionally, verbal and written, with nurses, physicians, leadership, and customers
Demonstrated ability to operate independently and as part of a team to follow directives
Prioritization, organizational, and critical thinking skills
Ability to multi-task
Commitment to quality and excellence
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. 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 Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. 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 age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.