Your Talent. Our Vision. At America's First Choice , a proud member of the Anthem,Inc. family of companies, it's a powerful combination, and the foundation uponwhich we're creating greater access to care for our members, greater value forour customers, and greater health for our communities. Join us and together wewill drive the future of health care.
Thisis an exceptional opportunity to do innovative work that means more to you andthose we serve at one of America's leading health benefits companies and aFortune Top 50 Company.
Responsible for coordinating cases for pre-certification 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 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.
Requires High school diploma/GED; 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. Medical terminology training and experience in medical or insurance field preferred.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 ofAmerica's Most Admired Companies among health insurers by Fortune magazine andis a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn moreabout our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.