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Posted: Tuesday, September 5, 2017 3:58 AM

/Your Talent. Our Vision/. At Anthem, Inc., it?s a powerful combination, and the foundation upon which we?re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.Utilization Management Representative I:Responsible for coordinating cases for precertification 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 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. * 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.Anthem, Inc. is ranked as one of America?s Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran. **Job** *Customer Service* **Title:** *Utilization Management Rep I - Newbury Park, CA - 132531* **Location:** *ohio-Cincinnati* **Requisition ID:** *132531* Company Description:We recently changed our name from WellPoint to Anthem, Inc., the name people know us by best. As our companies continue to take a more active role in helping people access the right health care and programs, going by a name that people know and trust is important.Anthem, Inc. is one of the nation's leading health benefits insurer and a Fortune Top 50 company. At Anthem, Inc., we are working to transform health care with trusted and caring solutions and meaningfully advance affordability and better health outcomes for our health plan members. Nearly 69 million people are served by our affiliated companies including more than 37 million enrolled in our family of health plans. One in nine Americans receives coverage for their medical care through Anthem's affiliated plans.We offer a broad range of medical and specialty products.Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to help drive the future of health care.Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our co

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• Location: Cincinnati

• Post ID: 49267882 cincinnati
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