Anthem Utilization Management Representative I - San Diego, CA - September 5th-132609 in San Diego, California

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater 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 I:

Responsible for coordinating cases for precertification and prior authorization review.

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.

  • Requires High school diploma/GED;

  • 1 year of customer service 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.
  • Team environment with an expectation that candidate will be able to multi-task and display flexibility in a changing business environment. Demonstrate proactive communication to manager and leads related to changing work load, exhibit professional conduct in all interactions, and understand the importance of the individual team member's role in supporting and achieving an outstanding Intake team.

/ Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran. /

Job Customer Service

Title: Utilization Management Representative I - San Diego, CA - September 5th-132609

Location: CA-San Diego

Requisition ID: 132609