Utilization Management Representative-FEP Program-IN- 61441
WellPoint - Indianapolis, IN

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WellPoint is one of the nations leading health benefits companies and a Fortune Top 50 company. At WellPoint, we are dedicated to improving the lives of the people we serve and the health of our communities. WellPoint strives to simplify the connection between health, care, and value for our customers.

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.

Utilization Management Representative-FEP Program

This position is located in the Indianapolis, IN office

The Utilization Management Representative will be responsible for coordinating cases for precertification and prior authorization review. Primary duties may include, but are not limited to Managing incoming calls in a fast paced, high volume call center, determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and advanced benefit determination; 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.

Job Qualifications

Requires High school diploma.

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.

Must be proficient with Microsoft Office, especially Word and Excel.

Must be able to work a 10:30 a.m.-7:00 p.m. schedule Monday-Friday.

Once an offer is accepted, all external applicants are subject to a background investigation
and if appropriate, drug testing. Offers of employment shall be contingent upon
passing both the background investigation and drug testing (if required).

  • Current WellPoint associates: All referrals must be submitted through the formal
associate referral process on WorkNet. Official guidelines for the associate referral
program can be found in My HR.

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WellPoint, Inc. (WellPoint) is a health benefits company serving 35 million medical members, as of December 31, 2008. The Company is an...