Anthem, Inc. Utilization Management Rep I in Norfolk, 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 non-clinical tasks including performing outreach to members to connect them with a nurse for program enrollment and engagement, working faxes and calling facilities to request clinical. Primary duties may include, but are not limited to:
• A strong ability to work independently as well in small teams while contributing in a supportive way to the larger team. • Handling incoming calls accurately and in a positive way, routing them to the correct team as needed. • Determining contract and program benefit eligibility as part of the outreach process. • Referring calls and cases requiring clinical review to a Nurse reviewer as needed through performing outreach, working faxes, account pool callouts and incoming calls. • Responsible for accurate and complete documentation of work in all appropriate systems. • Must have excellent communication skills as well as an ability to pay close attention to detail, to multitask and to prioritize work effectively. • Responds to telephone and written inquiries from clients, providers and in-house departments including task, letter, predetermination, and AMR creation. • 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. • Responsible for tracking production, running, and working reports, actively participating in the team plan daily. • Some examples of assorted projects include mentoring, creating job aids and assorted administrative tasks.
• 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. • 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.