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Utilization Management Representative I - Newbury Park, CA (PS13434) in Thousand Oaks, CA at Anthem, Inc.

Date Posted: 10/12/2018

Job Snapshot

Job Description

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.

An Utilization Management Representative I is responsible for coordinating cases for pre-certification and prior authorization review. 

Primary duties may include, but are not limited: 
  • Managing incoming calls or incoming post services claims work. 
  • Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient pre-certification, 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.

  • High school diploma/GED.
  • 1 year of customer service or call-center experience.
  • Or any combination of education and experience, which would provide an equivalent background.
  • Proficient analytical, written and oral communication skills.
  • Medical terminology training and experience in medical or insurance field preferred. 
  • CCB and WMDS experience 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.