Location Virtual full‑time with hybrid training. Candidates must be within a reasonable commuting distance to the posting location(s). Shift hours are Monday through Friday 7:00 AM – 5:00 PM Pacific.
Responsibilities Managing incoming calls or post services claims work.
Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precert, prior authorization, and post service requests.
Refers cases 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.
Associates in this role are expected to have the ability to multi‑task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.
Additional expectations to include but not limited to: 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, both with virtual and in‑person interactions; attentive to details, critical thinker, and a problem‑solver; demonstrates empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.
Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.
Performs other duties as assigned.
Qualifications High school diploma or GED and a minimum of 1 year of customer service or call‑center experience; 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 professional competencies apply: strong oral, written and interpersonal communication skills, problem‑solving skills, facilitation skills, and analytical skills.
Benefits Comprehensive benefits package including 401(k) with company match, stock purchase plan, medical, dental, vision, short‑ and long‑term disability, paid time off, incentive and recognition programs, and other wellness and financial education resources.
Equal Employment Opportunity Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.