Note: The job is a remote job and is open to candidates in USA. Atrium is hiring a temporary contractor to work at Humana, supporting utilization management operations. The role handles provider inquiries and prior authorization requests, helps callers navigate authorization processes, and performs administrative and documentation tasks while meeting service and quality standards.
Responsibilities
- Manage prior authorization inquiries and requests from healthcare providers
- Handle approximately 30 to 50 inbound calls per day in a fast-paced, performance-based environment
- Research and review information to determine whether requested services meet medical necessity guidelines
- Assist providers in navigating the authorization process to help ensure members receive appropriate care while minimizing unnecessary out-of-pocket costs
- Accurately document activities and maintain compliance with established procedures
- Utilize multiple systems simultaneously while adhering to detailed process flows
- Potentially support member calls as business needs evolve
- Meet productivity, quality, and customer service expectations
- Scheduled breaks and meal periods are assigned to ensure adequate staffing and maintain service levels for providers and members
Skills
- Minimum of 2 years of customer service experience, preferably within healthcare, insurance, or health services
- Strong customer service mindset and genuine enjoyment in helping providers and Medicare members over the phone
- Ability to manage a high-volume call environment, handling approximately 30 to 50 calls daily
- Typing proficiency of at least 30 words per minute
- Ability to learn and retain complex information through virtual training
- Comfortable following detailed multi-step procedures while maintaining accuracy
- Analytical, problem-solving, and organizational skills
- Ability to work independently with minimal supervision
- Excellent verbal and written communication skills
- Active listening capabilities
- High attention to detail and commitment to quality
- Demonstrated technical aptitude and ability to navigate multiple computer systems simultaneously
- Experience using Microsoft Office applications and comfortable utilizing toolbars, menus, and system features to efficiently locate, retrieve, and manage documents
- Strong work ethic and commitment to attendance and reliability
- Passion for improving customer experiences and supporting healthcare access
- Ability to thrive in a structured, fast-paced environment
- Demonstrates Humana's core values of being Curious, Committed, and Caring
- Ability to participate in meetings and training with a webcam is required
- Reliable childcare or dependent care arrangements during work hours
- 25 Mbps download
- 10 Mbps upload
- Direct wired connection to the internet router (Wi-Fi is not permitted)
- Comfort appearing on camera when required
- Ability to learn new systems quickly and adapt to changing business needs
- Experience with Utilization Management (UM), Prior Authorization, Utilization Review, or Care Coordination
- Healthcare insurance or managed care experience
- Knowledge of medical terminology, ICD-10 codes, and healthcare authorization processes
- Customer service experience within healthcare or insurance environments
- Previous phone-based member or provider support experience
- Familiarity with Genesys or similar authorization management systems
- Strong customer service experience, preferably in healthcare or insurance
- Knowledge of utilization management concepts, prior authorization processes, and medical coding
Benefits
- Remote work-from-home position
- Comprehensive benefits package available based on eligibility
- Medical, Dental, Vision
- Short-Term Disability (STD)
- Long-Term Disability (LTD)
- Supplemental and Voluntary Life Insurance
- 401(K)
- Commuter Benefit Program
Company Overview
Company H1B Sponsorship