Utilization Management Representative I

Elevance Health

. Coordinate cases for precertification and prior authorization review .

Posted 11/9/2026full-timeWinston-Salem • North Carolina • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing precertification and prior authorization processes while providing exceptional customer service. Proficient in medical terminology and capable of conducting clinical screenings and benefit eligibility determinations.

Highest-signal resume keywords

Customer Service ExperienceMedical Terminology KnowledgeAnalytical SkillsProblem-Solving SkillsCommunication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Precertification CoordinationPrior Authorization ManagementBenefit Eligibility DeterminationClinical Screening ProcessReferral Request Entry

Soft Skills

Interpersonal CommunicationAttention to DetailEmpathyCritical ThinkingMulti-Tasking

Tools & Technologies

UM SystemDigital ToolsElectronic Queues

Certifications & Qualifications

HS DiplomaGED

Industry Keywords

Medical FieldInsurance FieldCustomer RelationsInpatient AdmissionOutpatient Precertification

About the role

Key responsibilities & impact

Coordinate cases for precertification and prior authorization review
Manage incoming calls and incoming post services claims work
Determine contract and benefit eligibility
Provide authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
Refer cases requiring clinical review to a Nurse reviewer
Identify and enter referral requests into the UM system according to the plan certificate
Respond to telephone and written inquiries from clients, providers, and in-house departments
Conduct the clinical screening process
Authorize initial sets of sessions to providers
Check benefits for facility-based treatment
Develop and maintain positive customer relations
Coordinate with various company functions to handle customer requests and questions appropriately and promptly
Perform other duties as assigned

Requirements

What you’ll need

HS diploma or GED
Minimum of 1 year of customer service or call-center experience
Any combination of education and experience which would provide an equivalent background
Medical terminology training and experience in medical or insurance field preferred
Strong oral, written and interpersonal communication skills
Problem-solving skills
Facilitation skills
Analytical skills
Ability to multi-task while handling calls, texts, facsimiles, and electronic queues
Ability to maintain focus during extended periods of sitting
Strong verbal and written communication skills for virtual and in-person interactions
Attention to detail, critical thinking, and problem-solving abilities
Empathy and persistence to resolve caller issues completely
Comfort and proficiency with digital tools and platforms
Ability to work a structured schedule with occasional overtime or flexibility based on business needs
Ability to work from the office as necessary

Benefits

Comp & perks

merit increases
paid holidays
Paid Time Off
incentive bonus programs
medical benefits
dental benefits
vision benefits
short and long term disability benefits
401(k) +match
stock purchase plan
life insurance
wellness programs
financial education resources
Virtual full-time work, except for required in-person training sessions
Flexible work-life integration
Occasional overtime or flexibility based on business needs