Utilization Management Representative I at Elevance Health

Miami, Florida, United States

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Not SpecifiedCompensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

HS diploma or GED
Minimum of 1 year of customer service or call-center experience (or any combination of education and experience providing equivalent background)
Ability to multi-task, including handling calls, texts, facsimiles, and electronic queues while taking notes and speaking to customers
Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment
Strong verbal and written communication skills for virtual and in-person interactions
Attentive to details, critical thinker, and problem-solver
Demonstrates empathy and persistence to resolve caller issues completely
Comfort and proficiency with digital tools and platforms
Ability to work a structured schedule (10 AM to 6:00 PM Eastern), with occasional overtime or flexibility based on business needs, including office work as necessary
Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills (for URAC accredited areas)

Responsibilities

Coordinate

Skills

Utilization Management

Precertification

Prior Authorization

Benefit Eligibility

Clinical Screening

Customer Service

Data Entry

Multitasking

Telephone Inquiries

UM System

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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