Medical Contact Center Representative – Inbound and Outbound
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Job Description
Remote healthcare contact center representative supporting patients and providers. Handling benefits inquiries, care-program enrollment, wellness outreach, and issue resolution across multiple channels.
Responsibilities:
- Provide friendly, accurate, and timely service to members/patients, providers, and stakeholders through inbound and outbound phone, email, chat, SMS, video calls, co-browser sessions, and other channels
- Listen to customer needs, demonstrate empathy and patience, build rapport, and establish trust
- Help customers navigate healthcare processes, resources, benefits, and care programs
- Protect customer privacy and PHI while complying with HIPAA and applicable laws
- Support departments including Claims, Utilization Management, Intake, Quality, Care Management, and Patient Engagement
- Answer questions about benefits, claims, eligibility, provider networks, prior authorizations, preventive health, and healthcare topics
- Research, resolve, document, and follow through on complex customer issues; escalate recurring issues and urgent clinical or behavioral health concerns
- Educate customers about 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 checks, preventive care reminders, gap-in-care closure, and wellness check-ins
- Handle inbound program inquiries, qualify interest, explain program value, and guide prospective enrollees through next steps
- Use approved scripts, talking points, call flows, and dialer workflows; manage call dispositions and meet productivity and quality targets
- Comply with TCPA, state do-not-call rules, scripting, and disclosure standards
- Meet or exceed 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 and passion for helping others
- Strong empathy, patience, rapport-building, persuasion, and objection-handling skills
- Excellent verbal and written communication, grammar, and pronunciation in English
- Ability to communicate clearly, concisely, and professionally
- Active listening and effective 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 with strong accountability
- Ability to handle stressful situations professionally and calmly
- Knowledge of medical terminology, healthcare benefits, and insurance processes
- Candidates with inbound and outbound customer service experience across multiple channels strongly preferred
- Bilingual skills are a plus
- Associate's, bachelor's, or master's degree preferred
- Ability to provide an internet connection with at least 100 Mbps download and 10 Mbps upload
Benefits:
- Work from Home / fully remote work
- Medical, Dental, and Vision plans
- 401(k) plan with a 3% employer match to a 6% contribution
- Life and Disability insurance
- Voluntary Life insurance options
- Employee Assistance Program (EAP)
- Paid time off plans
- Paid parental leave
- Learning and development resources
- Necessary work equipment provided at no charge
- Flexible remote work arrangement
- Full-time employees working 30 hours per week or more are eligible for the comprehensive benefits package
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