{"id":3496626,"url":"https://alion.io/job/excellus-bluecross-blueshield-utilization-management-services-representative-i-multiple-openings","title":"Utilization Management Services Representative I (Multiple Openings!)","company":{"id":1914672,"name":"Excellus BlueCross BlueShield","domain":"excellusbcbs.com","url":"https://alion.io/company/excellusbcbs","size_band":"1001-5000","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Workday","truth_index":{"grade":"B","score":80,"open_postings":6,"ghost_share":0,"stale_share":1,"repost_share":0,"time_to_fill_p50_days":17,"computed_at":"2026-11-01T06:10:25Z"}},"role":"Customer Success","role_family":"Customer Success","seniority":"middle","employment_type":"full_time","work_mode":"remote","remote_scope":"stated_countries","remote_scope_basis":"board_field","remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["Rochester, United States","Buffalo, United States","Albany, United States","United States"],"countries":["US"],"hiring_countries":["US"],"hiring_countries_total":1,"salary":null,"salary_estimate":{"min_usd":50000,"max_usd":96000,"period":"year","method":"role_seniority_country_remote_cell","sample_n":248},"experience_years_min":4,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"Microsoft Office","optional":false}],"status":"live","first_seen_at":"2026-10-29T00:00:00Z","employer_posted_date":"2026-10-29","last_verified_at":"2026-11-02T00:25:58Z","board_verified":true,"closed_at":null,"days_open":4,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":4},"description":"Job Description:\nSummary:\nThis position supports the Utilization Management (UM) workflows by providing administrative support and customer service. This position acts as a resource for both internal and external customers through completing timely and accurate inbound and/or outbound calls, creating authorizations via phone, Care Advance Provider Tool, and fax for inpatient and outpatient procedures, behavioral health, and durable medical equipment.\n\nEssential Accountabilities:\nLevel I\nFacilitates inbound and outbound calls to customers (members and providers) by delivering excellent customer-centered service providing information regarding services in a call center environment.\nResponds to customers in a professional, efficient manner to encourage public acceptance of products, services, and policies.\nPerform triage for UM Services.\nServes as the primary contact for providers regarding authorization requests.\nContacts members and providers concerning regulatory requirements relating to Department of Health (DOH) notifications and other regulatory requirements such as the National Committee for Quality Assurance (NCQA) guidelines.\nProvides timely response to all research inquiries from other departments and assures the response is thorough, accurate, and within regulatory timeframes.\nProcesses fax requests from the designated fax and system queues.\nConsistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.\nMaintains high regard for member privacy in accordance with the corporate privacy policies and procedures.\nRegular and reliable attendance is expected and required.\nPerforms other functions as assigned by management.\nLevel II (in addition to Level I Accountabilities)\nAssists and performs tasks associated with project and departmental management.\nBackup Team Leads by assisting with questions when needed.\nWork on assigned offline projects.\nProvides, prepares, and assists with preliminary support to multiple levels of providers and or members (as well as others as needed), including but not limited to physicians, skilled nursing facilities, mid-level providers, members, pharmacies, pharmacists, and support staff.\nProvide one-on-one support, coaching, and training to UM Services Reps.\nCollaborates with other key departments (Claims, Customer Service, related care management units) to ensure end-to-end process for authorizations, telephonic notifications, and/or care management referrals is accurate and complete.\nLevel III (in addition to Level II Accountabilities)\nAssists Team Leads with assigned tasks when necessary (including but not limited to authorizations, claims, care management referrals, monitoring and controlling inventory levels/call queues, timeliness, reporting).\nMeet departmental requirements for Facets UM Services workflows and PEGA.\nResolves escalated customer questions and complex concerns.\nAssists Medical Directors with scheduling Fair Hearings.\nAssists with coordinating Grievance and Appeals requests.\nAssist with all Blue Card Claims escalations.\nAssist management with the review and creation of desk level procedures, acting as a subject matter expert for UM Services.\nMinimum Qualifications:\nNOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.\nAll Levels\nHigh School Diploma or GED.\nExperience with using a desktop computer in a professional environment, preferably with Microsoft Office Products.\nCall center experience preferred, not required.\nStrong analytical and problem-solving skills.\nStrong written and verbal communication skills and ability to work within a team.\nDemonstrated organizational skills to manage multiple projects and priorities.\nSelf-motivated and able to work independently, as well as on intra- and inter-departmental teams where needed.\nLevel II (in addition to Level I Qualifications)\n2 years’ experience working with managed care or healthcare industry.\nAbility to apply in-depth knowledge of complex rules, such as those of the authorization process, regulatory processes/time frames, care management systems and processes, departmental policies and procedures, product lines, and contract benefits.\nAdvanced skills working between multiple programs and applications simultaneously.\nDemonstrates willingness to develop collaborative solutions to achieve a better end-to-end process.\nDemonstrates proficiency in basic navigation and utilization of department specific applications.\nDemonstrates role-specific competencies as it pertains to their work unit on a consistent basis.\nActive demonstration of broad knowledge base and positive work habits as evidenced by ability to train new staff, take on new challenges, flexibility in work assignments, and participation in meetings and projects as assigned.\nLevel III (in addition to Level II Qualifications)\n4 years’ experience working with managed care or healthcare industry.\nDemonstrates a thorough knowledge and understanding of sources of information about health plan contracts, riders, policy statements, and procedures to identify eligibility and coverage and assisting other staff and other areas within the company with related inquiries.\nDemonstrates operational knowledge of FACETS application and workflow processes\nAbility to resolve/respond to customer inquiries across multiple plans with limited assistance.\nAbility to collaborate within the organization when issues arise with limited assistance.\nAbility to identify potential systemic issues and report as necessary without supervisor assistance.\nPhysical Requirements:\nAbility to work prolonged periods sitting at a workstation and working on a computer.\nAbility to work while sitting and/or standing while at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.\nAbility to work in a home office for continuous periods of time for business continuity.\nAbility to travel across the Health Plan service region for meetings and/or trainings as needed.\nManual dexterity including fine finger motion required.\nRepetitive motion required.\nThe ability to hear, understand and speak clearly while using a phone, with or without a headset.\n************\nIn support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.\nEqual Opportunity Employer\n Compensation Range(s):\nLevel I: Grade N3: Minimum: $20.40 - Maximum: $27.00\nThe salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.\nPlease note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.\nAll qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.","description_format":"text","description_chars":7934,"description_truncated":false,"requirements":{"experience_years_min":4,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":{"level":"high_school","optional":false},"security_clearance":false,"languages":[]},"benefits":["Dental insurance","Equity","Home office","Retirement plans"],"hiring_locations":[{"name":"United States","iso":"US","kind":"country"}],"hiring_excludes":[],"relocation_offered":false,"industries":["Health Insurance & Benefits"],"lifecycle":[{"event":"open","at":"2026-10-30T01:36:52Z"}],"visa":[],"liveness":{"score":90,"band":"hot","label":"Hiring now","p_open":1,"p_active":0.903,"p_room":1,"age_days":3,"expected_fill_days":17,"reasons":["conf:3","velocity","win:early"],"computed_at":"2026-11-01T06:10:25Z"},"pay":null,"html_url":"https://alion.io/job/excellus-bluecross-blueshield-utilization-management-services-representative-i-multiple-openings","json_url":"https://alion.io/job/excellus-bluecross-blueshield-utilization-management-services-representative-i-multiple-openings.json","meta":{"generated_at":"2026-11-02T03:33:11Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":5358,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-11-03T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":1914672},"rest":"https://alion.io/mcp/rest/get_company?id=1914672"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Fexcellus-bluecross-blueshield-utilization-management-services-representative-i-multiple-openings"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Fexcellus-bluecross-blueshield-utilization-management-services-representative-i-multiple-openings"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Fexcellus-bluecross-blueshield-utilization-management-services-representative-i-multiple-openings"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/excellus-bluecross-blueshield-utilization-management-services-representative-i-multiple-openings\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Fexcellus-bluecross-blueshield-utilization-management-services-representative-i-multiple-openings"}],"agent":{"mcp":"https://alion.io/mcp/jobs","mcp_open":"https://alion.io/mcp/open","next":[{"tool":"get_job","arguments":{"id":3496626}},{"tool":"search_jobs","arguments":{"company":"excellusbcbs.com","detail":"compact"}},{"tool":"match_people","arguments":{"job_id":3496626},"note":"people open to offers who fit this vacancy"}],"note":"The same data through MCP tools: https://alion.io/mcp/open needs no sign-in (compact searches, postings, people); https://alion.io/mcp with an Alion account has everything. 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