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Healthcare Customer Service Specialist (Medicare & Pharmacy Benefits)

Franklin, TN (Hybrid – 3 days onsite)
$16.79/hour
Monday–Friday | 8:00 AM – 5:00 PM CT

Position Overview

We are seeking a detail-oriented and customer-focused Healthcare Customer Service Specialist to support Medicare-related inquiries, prior authorizations, and appeals processing. In this role, you will serve as a key point of contact for agents, patients, and internal partners, providing guidance on prescription drug coverage and insurance benefits. This is a fast-paced, high-impact position requiring strong communication, organization, and problem-solving skills.

Key Responsibilities

• Handle inbound and outbound calls related to Medicare plans and pharmacy benefits
• Process and support prior authorizations and appeals for prescription medications
• Explain insurance benefits, coverage details, and reimbursement processes
• Document all interactions accurately in case management systems
• Track, manage, and follow up on multiple cases simultaneously
• Collaborate with internal teams, agents, pharmacies, and partners to resolve issues
• Maintain detailed records of cases, outcomes, and communications
• Assist with sales support inquiries and provide guidance to agents
• Navigate multiple systems and tools while delivering real-time support
• Participate in cross-training and support team operations as needed

Qualifications

• High school diploma or GED required (Associate’s degree preferred)
• 1–3 years of customer service experience (healthcare or insurance preferred)
• Knowledge of Medicare (Parts A, B, C, D) and prescription drug benefits is a strong plus
• Experience with prior authorizations, appeals, or pharmacy benefits preferred
• Strong verbal and written communication skills
• Ability to multitask and manage multiple systems simultaneously
• Detail-oriented with strong organizational and problem-solving abilities
• Basic computer proficiency (CRM systems, Microsoft Office, insurance portals)

Work Environment & Physical Requirements

• Hybrid schedule: 3 days onsite, 2 days remote
• Office setting with prolonged sitting or standing (7–10 hours/day)
• Occasional lifting up to 25 pounds
• Frequent computer use requiring typing and data entry
• Fast-paced, team-oriented environment

Preferred Skills

• Experience with case management or CRM systems (e.g., Salesforce, payer portals)
• Background in pharmacy benefits, PBM, or healthcare support services
• Ability to clearly explain complex insurance information to non-experts

Why Join Us?

• Stable weekday schedule (no nights or weekends)
• Opportunity to grow within healthcare and insurance operations
• Collaborative and supportive team environment
• Exposure to Medicare programs and pharmacy benefit management