DescriptionSHIFT: 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 benefits companies and a Fortune Top 50 Company.
Utilization Management Representative II
Responsible for managing incoming calls, including triage, opening of cases and authorizing sessions.
Primary duties may include, but are not limited to: 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. Obtains intake (demographic) information from caller. Conducts a thorough radius search in Provider Finder and follows up with provider on referrals given. Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization. Verifies benefits and/or eligibility information. May act as liaison between Medical Management and internal departments. Responds to telephone and written inquiries from clients, providers and in-house departments. Conducts clinical screening process.
- Requires HS diploma or equivalent and a minimum of 2 years customer service experience in healthcare related setting and medical terminology training; or any combination of education and experience which would provide an equivalent background.
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.
- Bachelor Degree in Behavioral Health 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.
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.
If you are active-duty military, reserve, or a military veteran, we foster a welcoming environment that’s dedicated to honoring your service and helping you achieve your career goals. Veterans of Anthem — one of our Business Resource Groups — partners with our Talent Acquisition teams to maximize career offerings for you and your family members, striving to help you transition to civilian service and grow your career at the same time.
Join Anthem's Military and Veteran Talent Network: https://anthemcareers.ttcportals.com/pages/military
WE ARE HIRING
Anthem, Inc. is currently seeking military veterans and military spouses for a variety of open roles. Our immediate needs include Support Technical Engineer, Lead Engineer, Developer, Systems Analyst, Network Data Specialist, and Provider Network Manager roles. Whether you are looking to transition into an IT career or if you have experience under your belt in the Technology field, Anthem wants to have an impact on your career and professional growth by speaking with you about their career opportunities.
If you are interested in learning more, check out Anthem's current open positions to the right for more information and to apply today!
Not sure where to start? Send RecruitMilitary Success Manager, Taylor Groves, your questions at email@example.com