Job Description

Required Skills and Experience:

• Minimum of 2 years of experience in a healthcare, insurance, or related field
• High school graduate and college or university experience
• Medical terminology knowledge or a medical background is required
• Strong understanding of health insurance processes, including claims management, benefits coordination, and prior authorization procedures
• Customer service experience is required
• Strong phone skills with experience handling inbound and outbound calls
• Experience with healthcare management software and databases
• Excellent verbal and written communication skills
• Ability to explain complex information in a clear and concise manner
• Strong problem-solving skills with the ability to analyze data and identify trends
• Attention to detail and accuracy in all work
• Ability to work collaboratively with cross-functional teams
• Demonstrated ability to build and maintain positive relationships with colleagues, clients, and stakeholders

Highly preferred:

• Two years of college or associate level degree equivalent
• Experience with providing high quality, provider focused servicing to facilities and doctors
• Work collaboratively as a team member with peers and nurses
• Concisely and accurately enter documentation into Care Advance
• Effectively engage over the phone via both inbound and outbound with providers
• Process provider requests as needed
• Acts as providers first trusted source for UM Prior Auth programs
• Assign faxes to designated staff
• Process requests for compliance inquiries
• Access various UM department mailboxes and voicemail as needed
• Ability to function independently
• Critical Thinking
• Bi-Lingual/Spanish