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Referral Specialist I

Company: Anthem, Inc
Location: Rancho Cordova
Posted on: January 11, 2022

Job Description:


SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

Referral Specialists responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals for various AIM services. AIM Specialty Health is a wholly-owned subsidiary of Anthem focused on specialty benefits management.

Location: This is a 100% remote position from day one forward. Successful candidates will meet Anthem Work at Home requirements including hard-wired high speed internet and a private secure workspace.

Hours: Successful candidates must be available to work any 8.5 hour shift between 8:30 M and 6:30 PM CST (Central Standard.) Your shift will be scheduled for 8.5 hours with two paid 15 minute breaks at set times and 30 minute unpaid break at a set time, resulting in 8 hours of work time daily.

This team supports a back-pain management program and will primarily be engaging with members during outbound calls. During these calls, you will be providing the members with information about that program and the unique opportunities we offer, then connecting the members with the clinical team. Additional duties may include, but are not limited to:

+ Initiates and manages clinical referrals for pre-authorization.

+ Acts as a liaison between hospital, health plans, physicians, patients, vendors and other referral sources.

+ Reviews referrals for completeness and follows up for additional information if necessary.

+ Assigns escalated referrals to staff as appropriate.

+ Verifies insurance coverage and completes pre-authorization process for radiology and other imaging exams (CT, MRI, MRA, PET, et.) following established process and procedures.

+ Responds to inbound calls initiating exam requests following established processes, meets quality and production standards.

+ Contacts physician offices as needed to obtain demographic information or related data.

+ Enters referrals, documents communications and actions in system.


The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against Covid-19. All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification. If you are not vaccinated, your offer will be rescinded unless you provide -and Anthem approves -a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.


+ HS diploma or GED; and

+ Minimum of 1 year of experience in a high-volume, interactive customer service or call center environment;

+ Or any combination of education and experience which would provide an equivalent background.


+ Knowledge of medical terminology

+ Healthcare experience

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.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For , is ranked as one of the 2020 World's Most Admired Companies among health insurers by Fortune magazine, and a 2020 America's Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com.

Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.


Keywords: Anthem, Inc, Rancho Cordova , Referral Specialist I, Other , Rancho Cordova, California

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