Client Services Specialist II - Agent Services Call Center

Prior authorizations and appeals processing. Ability to work in a fast paced environment, handling both inbound and outbound calls. Must be organized, detail-oriented and able to document cases clearly and accurately in accordance with the program guidelines. Good communication skills are essential, both internal and external. Knowledge of Medicare benefits, enrollments and LIS assistance. Plans and organizes work assignments, set priorities and completes work with a minimum of supervision. Adheres to the service policy and principles of the company, as well as the program guidelines set by the department. Participates in cross-training to perform all roles within the department. Communicates effectively and professionally with our program partners to assure the best possible service for our patients and partners. Other duties as assigned. Physical Demands: May sit, stand, stoop, bend and walk intermittently during the day. May sit or stand seven (7) to ten (10) hours per day. May be necessary to work extended hours as needed. Finger dexterity to operate office equipment required. May need to lift up to twenty-five (25) pounds on occasion. Visual acuity to see and read fine prints. Specific vision abilities required by this role include close vision, color vision and the ability to adjust focus. Must be able to hear normal voice sounds. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role. Work Environment: Work in a climate-controlled, smoke-free internal environment.

Safety Sensitive

• Location: Onsite @ Franklin-1021 Reams Fleming (Office) (TN3004)
○ Onsite: must be onsite 3 days a week - flexible on which days
• Schedule: Mon-Fri 8:00-5:00 PM CT

Tops 3 Skills:
1. Prescription Drug Reimbursement & Insurance Knowledge
This includes:
• Ability to explain benefit structures to agents or customers
This is the core of the role — without it, they will struggle immediately.

2. Strong Communication & Customer Service Skills
They must be able to:
• Handle inbound/outbound calls professionally
• Document clearly and accurately
• Communicate with agents, internal teams, manufacturers, and patients
• Deliver guidance, education, and problem-solving
This is a highly interactive, support‐heavy position.

3. Multi‐Tasking, Organization & Systems Navigation
This includes:
• Handling multiple cases and systems at once
• Documenting case notes consistently
• Managing multiple software tools
• Staying detail‐oriented in a fast‐paced environment
Without strong organizational skills, candidates won’t succeed.

****Pre-Screen Questions: Attach at top of Resume****
1. Which insurance types have you directly worked with? (Commercial, PBM, Medicare Parts A/B/C/D, LIS, specialty pharmacy, etc.) Please list and briefly describe your experience with each.

2. How many years of phone‐based customer service experience do you have, and what types of calls did you handle? (inbound, outbound, case support, benefit questions, etc.)

3. What systems or software have you used for case documentation or benefit verification? (Examples: CRM tools, case management platforms, Salesforce, NaviNet, payer portals)

4. Do you have experience managing multiple cases/tasks at once while keeping documentation accurate? If yes — briefly describe an example.

Verifyable High School Diploma or GED Required: Yes

Position Summary:
Customer Service Representatives are the face of Healthcare and impact the agent experience by manner of how customer service inquiries and problems via telephone, internet or written correspondence are handled. Engages, consults, and educates members based upon the member’s unique needs, preferences and understanding of Healthcare plans, tools, and resources to help guide the members along a clear path to care. Calls are typically non-routine and may require deviation from standard screens, scripts, and procedures to engage, consult and educate agents based upon the agent's unique needs, preferences and understanding of Healthcare plans, tools, and resources. In this role, you will act as a primary resource for our products and provide support for agents and/or customer teams. In this role you will learn how to help our agents grow their sales in the Medicare health market while building a strong and collaborative relationship with your team. Our department has a history of growth and is an encouraging and positive place to work. If you have a strong work ethic, cheerful outlook, and willingness to learn, along with the correct skills and qualifications, we would love to have you join our team. You will function as a primary resource for product and agent service support for field sales and/or customer teams.

Duties:
What will you do:
• Possesses knowledge all Healthcare health products available to the senior market.
• Gives guidance with sales inquiries.
• Manages various software applications while taking calls when needed and documents processes effectively.
• Cultivates positive and successful relationship with field sales force/broker/consultant community/customer teams.
• Navigates and instructs the customer on how to use agent support website.
• Completes sales orders and requests for materials.
• Trains and mentor other employees if needed.
• Assist Supervisor and Manager with providing support to the team.
• Consults cross-functionally with other departments to influence and promote change, to continually deliver quality service to both internal and external customers.
• Anticipates agent’s needs and educates agent on various elements of information and available services created to enhance the overall customer service experience with the company (i.e., assistance with agent self-service tools).
• May provide technical or subject matter expertise concerning policies, procedures, and function-related applications/systems tools.
• Documents and tracks all contacts, events, and outcomes with clients using appropriate systems and processes.

Experience:
Preferred Qualifications
• Customer Service - 1-3 Years of Experiences
• Strong Analytical Skills
• Basic computer skills
• Insurance Knowledge - Plus
• Critical Thinking
• Multi-Tasking
• Written and verbal communication are necessary skills.
Essential Qualifications
• Ability to read and comprehend simple instructions, short correspondence, and memos.
• Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization
• Working knowledge of problem solving and decision-making skills

Education
• High School Diploma required; associate’s degree preferred.

Education:
High School Diploma required; associate’s degree preferred.

What days & hours will the person work in this position? List training hours, if different. Mon-Fri 8:00-5:00 PM CT

Program Office - Point Of Contact: Courtney McHugh

Does this position require Fingerprinting? No