Health Program Representative

Job Summary

Supporting utilization management and specialty service operations, the full-time Health Program Representative I will coordinate provider requests, manage authorization-related activities, and serve as a liaison between healthcare providers and internal teams while working remotely with occasional in-person training sessions.

Key responsibilities

• Serve as the primary point of contact for providers and healthcare facilities regarding utilization management inquiries
• Coordinate peer-to-peer review scheduling and support authorization-related activities through various communication methods
• Maintain accurate records and ensure compliance with established policies and HIPAA regulations

Required qualifications

• High School Diploma or equivalent
• Minimum of 2 years of experience in Utilization Management, healthcare operations, or health insurance
• Basic knowledge of health insurance concepts and healthcare processes
• Ability to manage multiple priorities in a fast-paced environment
• Experience with customer service in a healthcare setting