Utilization Management Rep I

Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date. Primary Duties 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 HS 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. Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem‑solving skills, facilitation skills, and analytical skills. Medical background preferred (e.g., medical assisting, physician office experience, or healthcare setting). Experience with insurance claims or related administrative processes is a plus. Strong critical thinking and problem‑solving skills required. Excellent customer service and communication skills. Comfortable working in a phone‑based role and handling call volumes professionally. Job Type: Contract Monday through Friday, 8:00 AM – 5:00 PM. Role is virtual; however training may be hybrid (workers should prepare to be onsite up to 5 days a week). After training it will be virtual. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1‑hour commute each way of a relevant Elevance Health location. 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 based on disability. Benefits BCForward offers all eligible employees a comprehensive benefits package including, but not limited to, major medical, HSA, dental, vision, employer‑provided group life, voluntary life insurance, short‑term disability, long‑term disability, and 401(k). Benefits information: The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. This does not encompass additional non‑standard compensation (e.g., benefits, paid time off, per diem, etc.). #J-18808-Ljbffr Elevance Health