Anthem Blue Cross is a proud member of the WellPoint family of companies and is one of California’s oldest and largest health insurers. At Anthem, we are dedicated to improving the lives of the people we serve and the health of our communities.
Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.
Location: San Diego, CA.
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, college degree is preferred
- 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.
- Team environment with an expectation that candidate will be able to multi-task and display flexibility in a changing business environment.
- Demonstrate proactive communication to manager and leads related to changing work load, exhibit professional conduct in all interactions, and understand the importance of the individual team members role in supporting and achieving an outstanding Intake team.
WellPoint is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2012 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at www.wellpoint.com/careers. EOE