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Appeals Referral Specialist

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Elevance Health

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Location:
United States of America , Chicago

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Category:
Customer Service

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Contract Type:
Not provided

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Salary:

18.54 - 27.81 USD / Hour
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Job Description:

The Appeals Referral Specialist is responsible for providing support to a clinical team in order to facilitate the administrative components of clinical referrals.

Job Responsibility:

  • 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.
  • Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.
  • Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment.
  • Strong verbal and written communication skills, both with virtual and in-person interactions.
  • Attentive to details, critical thinker, and a problem-solver.
  • Demonstrates empathy and persistence to resolve caller issues completely.
  • Comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.
  • Performs other duties as assigned.

Requirements:

  • HS diploma or GED
  • 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.

Nice to have:

  • Knowledge of medical terminology preferred.
  • High-volume, interactive customer service or call center environment experience preferred.
  • Working in a hospital, physician's office, or medical clinic environment preferred.
  • Insurance pre-authorizations experience preferred.
What we offer:
  • comprehensive benefits package
  • incentive and recognition programs
  • equity stock purchase
  • 401k contribution
  • merit increases
  • paid holidays
  • Paid Time Off
  • incentive bonus programs
  • medical
  • dental
  • vision
  • short and long term disability benefits
  • 401(k) +match
  • stock purchase plan
  • life insurance
  • wellness programs
  • financial education resources

Additional Information:

Job Posted:
February 16, 2026

Expiration:
February 23, 2026

Employment Type:
Fulltime
Work Type:
Hybrid work
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