Medical Contact Center Representative – Inbound and Outbound
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Job Description
Medical contact center representative guiding patients through healthcare benefits and care programs at Guidehealth. Handling inbound service, outbound enrollment, and clinical wellness outreach remotely.
Responsibilities:
- Provide friendly, accurate, and timely service to members/patients, providers, and other stakeholders through inbound and outbound phone, email, chat, SMS, video calls, and co-browser sessions
- Listen to Customers' needs, demonstrate empathy and patience, build rapport, and establish trust
- Help Customers navigate healthcare processes, benefits, care programs, internal resources, and self-service portals
- Answer inquiries about benefits, claims, eligibility, provider networks, prior authorizations, preventive health promotion, and other healthcare topics
- Research, resolve, document, and follow through on complex Customer issues; escalate recurring issues and trends
- Educate Customers on plan benefits, policies, procedures, and healthcare information
- 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 guide next steps
- Use approved scripts, call flows, dialer workflows, and accurate call dispositions while meeting productivity and quality targets
- Escalate clinical, behavioral health, and urgent member needs appropriately
- Comply with HIPAA, TCPA, state do-not-call rules, scripting standards, and other applicable regulations
- Support Claims, UM, Intake, Quality, Care Management, and Patient Engagement departments
- 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 of 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 of 1 year of experience in a healthcare contact center or outbound calling environment
- Experience in both inbound and outbound Customer service via multiple channels strongly preferred
- Exceptional customer service skills
- Strong empathy, patience, rapport-building, and active listening skills
- Excellent verbal and written English communication, grammar, and pronunciation
- Strong persuasion and objection-handling skills
- Comfort with structured outbound calling, scripted call flows, and dialer-based workflows
- 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
- Ability to handle stressful situations professionally and calmly
- Knowledge of medical terminology, healthcare benefits, and insurance processes
- 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
- Comprehensive Medical, Dental, and Vision plans
- 401(k) plan with a 3% employer match to the employee's 6% contribution
- Life and 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 to the employee
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