Anthem, Inc. Utilization Management Rep III in New York, New York
SHIFT: Day Job
Responsible for coordinating cases for precertification and prior authorization review.
This level is expected to be able to perform all of the duties of the Utilization Management Rep II in addition to the following primary duties.
Primary duties may include, but are not limited to:
Responsible for providing technical guidance to UM Reps who handle correspondence and assist callers with issues concerning contract and benefit eligibility for requested continuing pre-certification and prior authorization of inpatient and outpatient services outside of initial authorized set.
Assisting management by identifying areas of improvement and expressing a willingness to take on new projects as assigned.
Handling escalated and unresolved calls from less experienced team members; ensuring UM Reps are directed to the appropriate resources to resolve issues.
Ability to understand and explain specific workflow, processes, departmental priorities and guidelines.
May assist in new hire training to act as eventual proxy for Ops Expert.
Exemplifies behaviors embodied in the 5 Core Values.
Requires a high school diploma/GED; 3 years of experience in customer service experience in healthcare related setting; or any combination of education and experience, which would provide an equivalent background.
Medical terminology training required.
For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Certain contracts require a Master's degree.
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.