CUSTOMER SERVICE AGENT

About WIN

At WIN, we believe everyone deserves expert, compassionate support through every stage of family life. From preconception and fertility to pregnancy, parenting, menopause, caregiving, and beyond, we’re transforming how people access care during life’s most meaningful moments.

While professional experience and qualifications are key for this role, make sure to check you have the preferable soft skills before applying if required.

For nearly 30 years, we’ve partnered with employers, health plans, and providers to improve outcomes, lower healthcare costs, and support more than 900,000 families around the world.

We're investing in our products, our people, and the future of well-being—and we're looking for teammates who are excited to help shape what's next.

POSITION SUMMARY

The individual in this role is responsible for delivering exceptional service to providers, pharmacies, and patients in alignment with company standards and contractual requirements.

Responsibilities:

The key responsibilities outlined below represent critical components of this position. Duties may be modified, updated, or reassigned at the discretion of management to meet evolving business needs.

• Processes a high volume of service authorization requests received via fax, phone, and online portals. This includes verifying member eligibility and benefits, documenting relevant clinical and administrative information (e.g., requested services or prescriptions, provider notes, and patient medical history) within the Authorization Tracking System (ATS).
• Forwards authorization requests to Care Management for clinical review and determination, as appropriate. Follows up with providers to obtain missing or additional information based on case requirements.
• Inputs service outcome details as provided by healthcare providers into the ATS.
• Conducts outbound communication with providers, provider office staff, pharmacies, and patients to ensure accurate processing and resolution of requests.
• Responds to a high volume of inbound calls from external customers. Engages professionally and effectively, utilizing call scripts, system information, and subject-matter knowledge to resolve inquiries.
• Maintains a thorough, up-to-date understanding of company policies, procedures, contractual obligations, relevant medical terminology (including infertility-related terminology), systems, and telephone protocols to deliver high-quality support.
• Appropriately escalates calls in accordance with established protocols and guidelines.
• Prepares prescription requests and submits approved prescriptions to partner pharmacies for fulfillment.

Requirements

MINIMUM QUALIFICATIONS

• High school diploma or equivalent required.
• At least two years of customer service experience in a call center environment or two years of medical office experience required.

Knowledge, Skills And Abilities

• Strong familiarity with medical terminology, as well as CPT and ICD-10 coding; prior experience is highly preferred.
• Working knowledge of HIPAA regulations is beneficial. xxzpjkt
• Previous customer service experience within the healthcare or health insurance industry is preferred.