UMR

Utilization Management Representative

Provides customer service to plan members by answering benefit questions, resolving issues, and educating members. Supports utilization management functions for selected services to ensure the correct application of contract and policy benefits are assigned.

Education/Experience

• High School Diploma/GED required
• One year in an insurance or healthcare setting.

Job Responsibilities:

• Review's member eligibility and benefit structure for requested referrals or prior authorizations.
• Responds to incoming calls from internal and external customers via multiple types of media.
• Review documentation and requests additional information needed to complete review of requested services.
• Initializes, routes, and completes, as appropriate, request for services. Informs members and providers of determination.
• Enters and maintains documentation per policy and procedures.
• Completes correspondence according to established workflows.
• Performs other duties and responsibilities as assigned

Digital Intelligence Systems, LLC (DISYS) is an Equal Opportunity Employer that recruits and hires qualified candidates without regard to race, religion, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.