Customer Care Representative I
DescriptionSHIFT: Day Job
Customer Care Representative I
Remote : Must reside in the state of Connecticut
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?
The associate in this position will be responsible for coordinating cases for precertification and prior authorization review.
How you will make an impact:
- From the moment you login, you'll be focused on proactively resolving our members and/or providers questions and concerns using computer-based resources to find answers.
- Manage incoming calls or post services claims work
- Determine contract and benefit eligibility
- Provide authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
- Refer 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
- Respond to telephone and written inquiries from clients, providers, and in-house departments
- Conduct clinical screening process
- Authorize initial set of sessions to provider
- Checks benefits for facility-based treatment
- Develop and maintain 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.
- Obtain intake (demographic) information from caller
- Conduct a thorough radius search in Provider Finder and follow up with provider on referrals given
- Refers cases requiring clinical review to a nurse reviewer, handle referrals for specialty care
- Process incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization
- May act as liaison between Medical Management and internal departments
Here's what Anthem offers:
- A career path with opportunity for growth
- Ability to obtain your Associate's or Bachelor's degree or further your education with tuition reiumbursement.
- Affordable Health Insurance, Dental, Vision and Basic Life
- 401K match, Paid Time Off, Holiday Pay
- Quarterly incentive bonus and annual increases plan based on performance.
At Anthem, the team is comprised of the best and the brightest from diverse experiences, cultures, and backgrounds. The differences we each bring to the table are a part of what makes our company so successful.
- Requires a HS diploma or equivalent and previous experience or any combination of education and experience which would provide an equivalent background.
- Ability to work from home with internet access and a quiet and private workspace
- Ability to work an 8-hour shift Monday - Friday between 8am and 5pm, possible weekend OT as needed
- Must reside in state of Connecticut
Preferred Skills, Capabilities and Experiences:
- Call center experience preferred.
- Medical terminology
- Computer skills - experience using MS Office products.
- A passion for serving others with the ability to be empathetic and the desire to go above and beyond to help resolve members questions at the first point of contact.
- A customer advocate willing to listen and find creative solutions to address and resolve customers questions, issues or concerns.
- A composed individual able to multi-task, navigating multiple computer applications and working efficiently while communicating and serving the customer.
- Must have a strong work ethic and sense of responsibility to your teammates and our members, demonstrated by the simplest things like being on time and available to meet member's needs, to being accountable for commitments made to customers or others and ensuring follow-ups are completed.
- Flexible and quick learner, willing to adapt to changing customer and business needs
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 [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.