Call Center Representative - Prior Authorization, Franklin

Call Center Representative – Prior Authorization Location: Franklin, TN (Hybrid – Onsite 3 days/week) Pay Rate: $*****/hour Schedule: Monday – Friday, 8:00 AM – 5:00 PM (CT) Work Type: Hybrid (must be onsite at least 3 days per week) Worksite Address: **** Reams Fleming Blvd, Franklin, TN Position Overview We are seeking a detail-oriented and customer-focused Call Center Representative – Prior Authorization to support prior authorization and appeals processing.
This role requires strong communication skills, the ability to manage multiple systems, and a solid understanding of prescription drug benefits and insurance processes.
Key Responsibilities Prior Authorization & Case Management Process prior authorizations and appeals in accordance with program guidelines Document cases clearly, accurately, and in a timely manner Manage multiple cases simultaneously while maintaining attention to detail Customer Support & Communication Handle inbound and outbound calls with professionalism Communicate effectively with patients, providers, agents, and internal teams Provide guidance on prescription benefits, coverage, and reimbursement processes Escalate issues as appropriate to ensure timely resolution Operations & Compliance Adhere to company policies and departmental program guidelines Maintain confidentiality and accuracy in all documentation Participate in cross-training to support multiple functions within the department Work independently while managing priorities in a fast-paced environment Top Required Skills
1. Prescription Drug & Insurance Knowledge Understanding of benefit structures and reimbursement processes Familiarity with Medicare benefits, enrollments, and LIS assistance preferred
2. Communication & Customer Service Strong verbal and written communication skills Ability to clearly explain complex information to customers and stakeholders Professional phone etiquette and problem-solving skills
3. Organization & Multitasking Ability to manage multiple systems and cases simultaneously Strong documentation and time management skills Detail-oriented with the ability to thrive in a fast-paced environment Qualifications High School Diploma or equivalent required Previous call center, healthcare, or insurance experience preferred Basic computer proficiency and ability to navigate multiple systems Physical & Work Environment Ability to sit or stand for extended periods (7–10 hours per day) Occasional lifting up to 25 lbs Work performed in a climate-controlled, smoke-free office environment Additional Information Safety-sensitive role Hybrid schedule with flexibility on in-office days Opportunity to grow within a dynamic, team-oriented environment Qualified candidates are encouraged to apply for immediate consideration.