Health Program Representative I (US)

Health Program Representative I

Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

The Health Program Representative I supports utilization management and specialty service operations by coordinating provider requests, authorization-related activities, peer-to-peer reviews, and administrative processes. This role serves as a key liaison between providers, healthcare facilities, internal business partners, and Medical Directors to ensure requests are processed accurately and efficiently.

How You Will Make an Impact

• Serve as a primary point of contact for providers, healthcare facilities, and internal business partners regarding utilization management and specialty service inquiries.
• Coordinate peer-to-peer review scheduling between providers and Medical Directors.
• Support authorization-related activities and utilization management workflows through phone, fax, and electronic work queues.
• Process, document, and maintain accurate records in accordance with established policies and procedures.
• Obtain and verify information from providers, health plans, facilities, and internal departments.
• Monitor and manage assigned workload to ensure timely completion of requests and inquiries.
• Utilize multiple systems simultaneously while maintaining accuracy and efficiency.
• Collaborate with internal clinical and operational teams to support business objectives and service-level expectations.
• Maintain compliance with HIPAA, privacy regulations, and company policies.
• Support client-specific projects, special initiatives, and operational requests as assigned.

Minimum Requirements

• High School Diploma or equivalent.
• Minimum of 2 years of Utilization Management, healthcare operations, health insurance, prior authorization, claims, or related healthcare experience.
• Strong customer service experience.
• Basic knowledge of health insurance concepts and healthcare processes.
• Ability to manage multiple priorities in a fast-paced environment.
• Strong verbal and written communication skills.
• Ability to work independently with limited supervision.

Preferred Qualifications

• Utilization Management experience.
• Prior authorization experience.
• Health insurance industry experience.
• Knowledge of medical terminology.
• Knowledge of ICD-9, ICD-10, and CPT coding principles.
• GBAS experience preferred.
• Experience supporting providers, healthcare facilities, or clinical operations.
• Experience with HIPAA requirements, electronic filing, and faxing processes.
• Experience working with multi-line phone systems.
• Intermediate proficiency in Microsoft Word and Excel.

Ideal Candidate Profile This role is ideal for individuals with healthcare operations, utilization management, or health insurance experience who enjoy coordinating complex processes, supporting providers, and working across multiple teams. Candidates with prior authorization experience, medical terminology knowledge, and strong organizational skills will be particularly successful in this position.

Work Environment & Schedule

• 100% remote role.
• Company-provided equipment.
• Reliable high-speed internet required.
• Backup power source recommended.
• Training schedule may vary based on the candidate's location/time zone, mentor availability, and business needs.
• Work schedules are determined based on operational needs and team coverage requirements.
• Occasional weekend coverage may be required.

What Success Looks Like

Successful associates in this role:

• Demonstrate strong attention to detail and accuracy.
• Effectively manage competing priorities and deadlines.
• Build positive working relationships with providers and internal partners.
• Communicate professionally and confidently in a variety of situations.
• Work independently with minimal supervision.
• Demonstrate reliability, dependability, flexibility, and strong attendance.
• Maintain composure and professionalism during challenging or high-volume situations.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $14.61-$21.91/hourly.

Locations: Idaho, Georgia, Virginia, Florida, Alabama, and Illinois

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

*The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.