Utilization Management Representative I – Backoffice Support

Elevance Health

Utilization management representative processing healthcare authorization requests for Elevance Health. Reviewing documentation, entering authorizations, and coordinating back-office correspondence.

Posted 8/19/2026full-timeAtlanta • Connecticut, Florida • 🇺🇸 United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates proficiency in processing precertification, prior authorization, and post-service requests while adhering to HIPAA and regulatory requirements. Capable of managing tasks independently in a high-volume, compliance-focused environment with strong communication and problem-solving skills.

Highest-signal resume keywords

Utilization ManagementHIPAA ComplianceData EntryCustomer Service ExperienceMedical Terminology

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Precertification ProcessingPrior AuthorizationDocument ProcessingReferral ManagementClaims ProcessingHealthcare CorrespondenceAnalytical SkillsProblem-Solving SkillsQuality AssuranceCompliance Management

Soft Skills

Interpersonal CommunicationWritten CommunicationFacilitation Skills

Tools & Technologies

Document-Management SystemsElectronic Work QueuesEmail

Industry Keywords

Healthcare OperationsPrivacy RequirementsRegulatory ComplianceHigh-Volume EnvironmentConfidentiality

About the role

Key responsibilities & impact

Process precertification, prior authorization, and post-service requests for governmental and commercial lines of business
Review and process utilization management requests received through fax, electronic queues, and other approved channels
Enter referral and authorization information accurately into utilization management systems
Prepare and send complete and accurate fax correspondence to providers, facilities, members, and internal partners
Meet departmental productivity, quality, accuracy, and turnaround-time standards while maintaining a low error rate
Review documentation for completeness and refer cases requiring clinical review to the appropriate clinical reviewer
Verify benefits and administrative requirements within the scope of the role
Document all actions and correspondence accurately and completely
Monitor queues, prioritize tasks, follow work through completion, and promptly escalate barriers
Protect confidential information and comply with HIPAA, privacy, security, company, accreditation, contractual, and regulatory requirements
Identify and report potential quality, privacy, compliance, or regulatory concerns through established escalation processes
Perform other duties as assigned
Primarily perform back-office work with no inbound call responsibilities; make limited outbound calls when needed to obtain information or support case resolution

Requirements

What you’ll need

High school diploma or GED
Minimum of 1 year of customer service or call-center experience
Any combination of education and experience providing an equivalent background
Administrative support, healthcare operations, data entry, document processing, or back-office experience strongly preferred
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 meet established productivity, quality, accuracy, compliance, and turnaround-time expectations preferred
Ability to manage assigned work independently, maintain confidentiality, and follow detailed policies and procedures preferred
Proficiency with computers, electronic work queues, email, and document-management systems preferred
Experience processing faxes, referrals, authorizations, claims, medical records, or healthcare correspondence preferred
Knowledge of HIPAA and healthcare privacy requirements preferred
Experience working in a high-volume, production-based, compliance-focused environment preferred
Availability to work an assigned Monday-Friday shift between 8:00 a.m. and 8:00 p.m. Eastern Time
Must comply with HIPAA, privacy and security requirements, company policies, accreditation standards, contractual obligations, and applicable federal and state regulations
New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless an acceptable explanation is provided

Benefits

Comp & perks

Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical benefits
Dental benefits
Vision benefits
Short-term disability benefits
Long-term disability benefits
401(k) with match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Virtual full-time work arrangement, except for required in-person training sessions