Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for contract workers (via BCforward) who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

-CANDIDATES MUST RESIDE IN THE FOLLOWING STATES:MA, or in RI, CT, NH or NY.-

Primary duties may include, but are not limited to:

• 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.
• Responsible for managing incoming calls, including triage, opening of cases and authorizing sessions.
• Obtains intake (demographic) information from caller.
• Conducts a thorough radius search in Provider Finder and follows up with provider on referrals given.
• Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care.
• Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization.
• Verifies benefits and/or eligibility information.
• May act as liaison between Medical Management and internal departments.
• Responds to telephone and written inquiries from clients, providers and in-house departments.
• Conducts clinical screening process.

Requirements:

• HS diploma or equivalent.
• 2 years customer service experience in healthcare related setting and medical terminology training; or any combination of education and experience, which would provide an equivalent background.
• Experience with mental health crisis and or assessment needed, ability to engage, build rapport with individuals reaching out for help in a crisis, and to de-escalate crisis and provide support.
• This is a position with 988 Text/Chat back-up team, working with people from all over the country.
• High quality customer service, must be able to type comfortably, at ease with technology.

Additional Details:

• WFH, remote option available.
• Training will be regular business hours, Mon-Fri, for two weeks.
• Permanent schedules will vary40 hours weekly, one is first shift the other is second shift
• Works as part of a team: Licensed Supervisors are available 24/7 for support and assistance, candidates should be prepared to work with a variety of individuals.

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 on the basis of disability.

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