Utilization Management Representative I – Backoffice Support

🕒 August 31

🌲 North Carolina, Virginia – Remote

🌲 North Carolina – Remote ⚔️ Virginia – Remote

💵 $15 - $23 / hour

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Process precertification, prior authorization, and post-service requests for governmental and commercial lines of business • Review and process utilization management requests received through fax, electronic queues, and other approved channels • Enter referral and authorization information accurately into utilization management systems • Prepare and send clear, complete, and accurate fax correspondence to providers, facilities, members, and internal partners • Meet departmental productivity, quality, accuracy, and turnaround-time standards while maintaining a low error rate • Review documentation for completeness and refer cases requiring clinical review to the appropriate clinical reviewer • Verify benefits and administrative requirements within the scope of the role • Document all actions and correspondence accurately and completely • Monitor queues, prioritize tasks, follow work through completion, and promptly escalate barriers • Protect confidential information and comply with HIPAA, privacy and security requirements, company policies, accreditation standards, contractual obligations, and applicable regulations • Identify and report potential quality, privacy, compliance, or regulatory concerns through established escalation processes • Perform other duties as assigned • Primarily perform back-office work with no inbound call responsibilities; make limited outbound calls when needed to obtain information or support case resolution

🎯 Requirements

• High school diploma or GED and a minimum of 1 year of customer service or call-center experience, or an equivalent combination of education and experience • Availability Monday through Friday for an assigned shift between 8:00 a.m. and 8:00 p.m. Eastern Time • Administrative support, healthcare operations, data entry, document processing, or back-office experience strongly preferred • Medical terminology training and experience in the medical or insurance field preferred • Strong oral, written, and interpersonal communication skills • Problem-solving, facilitation, and analytical skills • Ability to meet productivity, quality, accuracy, compliance, and turnaround-time expectations preferred • Ability to manage assigned work independently, maintain confidentiality, and follow detailed policies and procedures preferred • Proficiency with computers, electronic work queues, email, and document-management systems preferred • Experience processing faxes, referrals, authorizations, claims, medical records, or healthcare correspondence preferred • Knowledge of HIPAA and healthcare privacy requirements preferred • Experience in a high-volume, production-based, compliance-focused environment preferred • Ability to work within commuting distance of a posting location unless an accommodation is granted • New hires in certain patient/member-facing roles must be vaccinated against COVID-19 and Influenza unless an acceptable explanation is provided

🏖️ Benefits

• Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401(k) contribution and match • Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical benefits • Dental benefits • Vision benefits • Short- and long-term disability benefits • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Virtual work flexibility • Professional and personal growth opportunities