[Hiring] Health Program Representative I @Elevance Health

Role Description

The Health Program Representative I supports utilization management and specialty service operations by coordinating provider requests, authorization-related activities, peer-to-peer reviews, and administrative processes. This role serves as a key liaison between providers, healthcare facilities, internal business partners, and Medical Directors to ensure requests are processed accurately and efficiently.

How You Will Make an Impact:

• Serve as a primary point of contact for providers, healthcare facilities, and internal business partners regarding utilization management and specialty service inquiries.
• Coordinate peer-to-peer review scheduling between providers and Medical Directors.
• Support authorization-related activities and utilization management workflows through phone, fax, and electronic work queues.
• Process, document, and maintain accurate records in accordance with established policies and procedures.
• Obtain and verify information from providers, health plans, facilities, and internal departments.
• Monitor and manage assigned workload to ensure timely completion of requests and inquiries.
• Utilize multiple systems simultaneously while maintaining accuracy and efficiency.
• Collaborate with internal clinical and operational teams to support business objectives and service-level expectations.
• Maintain compliance with HIPAA, privacy regulations, and company policies.
• Support client-specific projects, special initiatives, and operational requests as assigned.

Qualifications

• High School Diploma or equivalent.
• Minimum of 2 years of Utilization Management, healthcare operations, health insurance, prior authorization, claims, or related healthcare experience.
• Strong customer service experience.
• Basic knowledge of health insurance concepts and healthcare processes.
• Ability to manage multiple priorities in a fast-paced environment.
• Strong verbal and written communication skills.
• Ability to work independently with limited supervision.

Requirements

• Utilization Management experience.
• Prior authorization experience.
• Health insurance industry experience.
• Knowledge of medical terminology.
• Knowledge of ICD-9, ICD-10, and CPT coding principles.
• GBAS experience preferred.
• Experience supporting providers, healthcare facilities, or clinical operations.
• Experience with HIPAA requirements, electronic filing, and faxing processes.
• Experience working with multi-line phone systems.
• Intermediate proficiency in Microsoft Word and Excel.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).