Medical Contact Center Representative – Inbound and Outbound
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Job Description
Remote contact center representative guiding U.S. healthcare members through benefits, enrollment, and care-management programs. Handling inbound support and outbound clinical-quality outreach for Guidehealth, a value-based healthcare company.
Responsibilities:
- Provide friendly, accurate, and timely service to members/patients, providers, and other stakeholders through inbound and outbound phone, email, chat, SMS, video calls, co-browser sessions, and other channels
- Listen to Customers’ needs and concerns, demonstrate empathy, build rapport, and establish trust
- Help Customers navigate internal processes, resources, healthcare benefits, and care programs
- Answer inquiries about benefits, claims, eligibility, provider networks, prior authorizations, preventive health promotion, and healthcare topics
- Research, resolve, document, and follow through on complex Customer issues; escalate recurring issues and trends
- Educate Customers on plan benefits, policies, procedures, self-service portals, and available resources
- Conduct outbound enrollment outreach for care management and care coordination programs
- Conduct clinical quality and wellness outreach, including medication refill reminders, blood pressure check-ins, preventive care reminders, gap-in-care closure, and wellness check-ins
- Handle inbound inquiries from prospective enrollees, qualify interest, explain program value and benefits, and guide next steps
- Use approved scripts, talking points, call flows, and dialer-based workflows; manage call dispositions and meet productivity and quality targets
- Escalate clinical, behavioral health, and urgent member concerns appropriately
- Support Claims, Utilization Management, Intake, Quality, Care Management, and Patient Engagement departments
- Protect PHI and comply with HIPAA, TCPA, state do-not-call rules, company policies, and applicable regulations
- Meet performance goals for CSAT, first contact resolution, quality, efficiency, attendance, and schedule adherence
- Participate in training, coaching, professional development, and process improvement
Requirements:
- High school diploma or equivalent required
- Minimum 2 years of experience in customer service in a health plan, HMO, TPA, or healthcare setting, or program enrollment, telemarketing, cold calling, appointment setting, inside sales, or other outbound calling roles
- Minimum 1 year of experience in a healthcare contact center or outbound calling environment
- Exceptional customer service skills
- Strong empathy, patience, rapport-building, persuasion, and objection-handling skills
- Excellent verbal and written communication, grammar, and English pronunciation
- Active listening and customer-needs assessment skills
- Comfort with structured outbound calling, scripted call flows, and dialer-based workflows
- Resilience when handling refusals, voicemails, unanswered calls, and repetitive dialing volume
- Strong problem-solving and critical-thinking abilities
- Ability to navigate complex systems and processes
- Proficiency with computer systems, CRM software, and Microsoft Office Suite
- Ability to learn and retain information quickly
- Ability to work independently and as part of a team
- High accountability and ability to handle stressful situations professionally
- Knowledge of medical terminology, healthcare benefits, and insurance processes
- Experience with inbound and outbound customer service through multiple channels strongly preferred
- Bilingual skills a plus
- Associate’s, bachelor’s, or master’s degree preferred
- Ability to provide internet with minimum 100 Mbps download and 10 Mbps upload
- Must be accessible during stated working hours and participate in virtual meetings with cameras on
Benefits:
- Work from home / fully remote work
- Medical insurance
- Dental insurance
- Vision insurance
- 401(k) plan with a 3% employer match to the employee’s 6% contribution
- Life insurance
- Disability insurance
- Voluntary Life options
- Employee Assistance Program (EAP)
- Paid time off plans
- Paid parental leave
- Learning and development resources
- Necessary work equipment provided at no charge
- Full-time employees working 30 hours per week or more eligible for comprehensive benefits
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