What are the responsibilities and job description for the Utilization Management Rep I position at Anthem?
Job ID: JP00046732
Anticipated Start Date: 08/24/2026
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.
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.
Reside in the Tampa, FL area.
Preferred
Medical terminology training and experience in medical or insurance field.
Medical background or healthcare experience.
Prior authorization, claims, or insurance experience.
Strong communication, customer service, and problem-solving skills.
Ability to multitask and work efficiently in a fast-paced environment
Proficient with computers and multiple systems.
Contract type
Contract
Additional Details
Work Details Monday - Friday 8am-5pm
The position is remote. The training will be onsite in the Tampa office for 1-2 weeks.
5411 Sky Center Drive, Tampa, FL
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