Anthem Inc. Medical Jobs

Job Information

Anthem, Inc. Utilization Management Rep I or II in Indianapolis, Indiana

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 benefits companies and a Fortune Top 50 Company.

Utilization Management Representative I or II

Location: Office-based; 8085 Knue Road Indianapolis, IN

Hours: Availability between 10:30 am - 7:00 pm Monday-Friday

Training: 8:00 am - 4:30pm Monday-Friday

This position is posted as a job family and the selected candidate will be placed into the job level commensurate with their experience

Responsible for coordinating cases for pre-certification and prior authorization review. Primary duties may include, but are not limited to:

  • Managing incoming calls within in-bound call center environment.

  • 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.

Qualifications

Qualifications:

Additional Experience:

  • Experience in medical or insurance field preferred.

  • Experience with Microsoft Office Products (Word, Excel, Outlook)

  • Proficiency with typing.

  • Experience with FEP Direct, ACMS preferred, but not required.

  • Experience with utilization management preferred.

  • Experience with NCQA preferred, but not required.

  • Must be able to between 10:30am - 7:00pm local time.

UM Rep I

  • Requires High school diploma/GED;

  • Minimum 1 year of customer service or call-center experience;

  • Proficient analytical, written and oral communication skills;

  • or any combination of education and experience, which would provide an equivalent background.

UM Rep II

  • Requires a high school diploma/GED;

  • 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.

  • Certain contracts require a Masters’ degree.

For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

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 careers.antheminc.com An Equal Opportunity Employer/Disability/Veteran

REQNUMBER: PS43578

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