Utilization Review Customer Service Representative
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Job Description
Customer Service Representative handling utilization review calls from injured workers. Requires strong communication skills and provides accurate information and support.
Responsibilities:
- Assist in evaluating the medical necessity, appropriateness and efficiency of the health care services and procedures.
- Answer phones for the utilization review department.
- Performs other duties as assigned.
- Supports the organization's quality program(s).
Requirements:
- High school diploma or GED required.
- One (1) year of experience with workers compensation legal and regulatory requirements and quality/managed care concepts or equivalent combination of education and experience required.
- Knowledge of workers compensation claims procedures and state legal and regulatory requirements.
- Good customer service skills.
- Good oral and written communication skills.
- PC literate, including Microsoft Office products.
- Excellent interpersonal skills.
- Good organizational and time management skills.
- Good problem-solving skills.
- Good analytical skills.
- Ability to manage multiple and changing priorities.
- Ability to work in a team environment or independently with little supervision.
- Ability to meet or exceed Performance Competencies.
Benefits:
- Three Medical and two dental plans to choose from.
- Tuition reimbursement eligible.
- 401K plan that matches 50% on every $ you put in up to the first 6% you save.
- 4 weeks PTO your first full year.
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