Anthem Utilization Management Representative I- Norfolk, VA; Las Vegas, NV- 5/13/19- PS18870 in Santa Ana, California

Utilization Management Representative I- Norfolk, VA; Las Vegas, NV- 5/13/19- PS18870

Location: United States

Field: Customer Service

Requisition #: PS18870

Post Date: Mar 13, 2019

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 atone of America's leading health benefits companies and a Fortune Top 50 Company.

Utilization Management Representative I:

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.

  • Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

  • Bi-lingual preferred

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran