Pre Authorization Support With After Hour Support

An inbound hotline agent for prior authorization inquiries. Identifies the caller type — provider's office, pharmacy, or member — and routes accordingly, with full after-hours handling that captures a callback number when the office is closed.

During business hours, the agent verifies member identity (name and date of birth, with read-back confirmation), looks up the member's prior authorization cases by medication name, confirms the case back to the caller, and reads the current status along with what happens next (e.g., automatic fax to the provider on a final decision). Cleanly escalates to a specialist when no case is found or when the caller needs information beyond what's in the system.