Health Program Representative I

🔥 58 minutes ago

🏈 Alabama, Florida, +4 more states – Remote

🏈 Alabama – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote ⚔️ Virginia – Remote 🍑 Georgia – Remote

💵 $14 - $21 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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• Just posted.
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Elevance Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Elevance Health is transforming from a traditional health benefits organization into a lifetime trusted health partner, driven by a bold purpose to improve the health of humanity. With nearly 100,000 associates, they serve over 118 million people and utilize an integrated whole health approach supported by industry-leading capabilities and a digital health platform. Their mission includes redefining health, reimagining the health system, and strengthening communities.

📋 Description

• Serve as a primary point of contact for providers, healthcare facilities, and internal business partners regarding utilization management and specialty service inquiries. • Coordinate peer-to-peer review scheduling between providers and Medical Directors. • Support authorization-related activities and utilization management workflows through phone, fax, and electronic work queues. • Process, document, and maintain accurate records according to established policies and procedures. • Obtain and verify information from providers, health plans, facilities, and internal departments. • Monitor and manage assigned workload to ensure timely completion of requests and inquiries. • Utilize multiple systems simultaneously while maintaining accuracy and efficiency. • Collaborate with internal clinical and operational teams to support business objectives and service-level expectations. • Maintain compliance with HIPAA, privacy regulations, and company policies. • Support client-specific projects, special initiatives, and operational requests as assigned.

🎯 Requirements

• High School Diploma or equivalent. • Minimum of 2 years of Utilization Management, healthcare operations, health insurance, prior authorization, claims, or related healthcare experience. • Strong customer service experience. • Basic knowledge of health insurance concepts and healthcare processes. • Ability to manage multiple priorities in a fast-paced environment. • Strong verbal and written communication skills. • Ability to work independently with limited supervision. • Utilization Management experience preferred. • Prior authorization experience preferred. • Health insurance industry experience preferred. • Knowledge of medical terminology preferred. • Knowledge of ICD-9, ICD-10, and CPT coding principles preferred. • GBAS experience preferred. • Experience supporting providers, healthcare facilities, or clinical operations preferred. • Experience with HIPAA requirements, electronic filing, and faxing processes preferred. • Experience working with multi-line phone systems preferred. • Intermediate proficiency in Microsoft Word and Excel preferred. • Reliable high-speed internet required. • Occasional weekend coverage may be required. • Must comply with HIPAA, privacy regulations, and company policies. • Candidates must reside within commuting distance from a posting location unless accommodation is granted as required by law.

🏖️ Benefits

• Company-provided equipment • Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401k contribution • Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical benefits • Dental benefits • Vision benefits • Short and long term disability benefits • 401(k) +match • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Virtual full-time work arrangement

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