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Utilization Management Representative I

Location: Tampa, FL
JobFamily: Customer Service
Req #: PS66237
Date Posted: Mar 8, 2022

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Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

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.

This position works an 8 hour shift between 8:00 a.m. to 5:00 p.m. Monday through Friday. 

Primary duties may includes, but are not limited:

  • Managing incoming calls or incoming post services claims work.
  • 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.

 

Qualifications

Requirements:

  • Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.
  • Medical terminology training and experience in medical or insurance field preferred.

Preferred Qualifications

  • For URAC accredited areas the following applies: Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills are preferred
  • Medical terminology training and experience in medical or insurance field preferred.

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 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. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.

Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.