Utilization Management Representative I-(Albany, NY) KG- 42043 - (US-NY-Albany - 12288)

Minimum Education: Tech School
Job Type: Full Time
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Empire BlueCross
is a distinguished leader in the health insurance industry and part of the WellPoint family of companies. As we build on our 70-year history serving the health insurance needs of New York State, we are focused on becoming indispensable to the customers and communities we serve and providing a rewarding career for our talented and diverse workforce.

Bring your expertise to our innovative, performance-focused culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.

The Utilization Management Representative will be responsible for coordinating cases for precertification and prior authorization review. They will manage incoming calls, including triage, opening of cases and authorizing sessions. They are also responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate. The Representative will respond to telephone and written inquiries from clients, providers and in-house departments. They will conduct clinical screening process and 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.

Skills:
* High school diploma or equivalent is required* Must have proficient written and oral communication and analytical skills* Requires good PC keyboard and Office software skills and PC proficient* Medical terminology training preferred* Minimum of one year of customer service or call-center experience* Experience in medical or insurance field preferred* Previous experience with Behavior Health is a plus

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