Job ID: JP43316

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for contract workers (via BCforward) who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Primary duties may include, but are not limited to:

• 
  Responsible for coordinating cases for precertification and prior authorization review.
• Managing incoming calls or incoming post services claims work.
• Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, 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.
  

Requirements:

• 
  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.
• Candidate needs to be able to multitask, needs to be able to be familiar with TEAMS, Excel, Microsoft word, and Outlook preferred.
• ACMP Experience, Facets Experience, reliable, fast work pace, and independent preferred.

Additional Details:

• Monday to Friday 830 am to 5 PM
• Candidates must reside in the state of Florida
• 100% remote role
• Possible temp to hire.

BCForward is An Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

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