Medical Contact Center Representative – Inbound/Outbound
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Job Description
Medical contact center representative guiding U.S. patients through benefits, care management, and wellness programs. Handling inbound support and outbound enrollment and clinical outreach for Guidehealth’s data-powered healthcare services.
Responsibilities:
- Provide friendly, accurate, and timely service through inbound and outbound interactions via phone, email, chat, SMS, video calls, co-browser sessions, and other channels
- Listen to Customers’ needs and concerns, demonstrate empathy, and build rapport and trust
- Help Customers navigate healthcare processes, benefits, care programs, and available resources
- Protect Customers’ privacy and PHI and comply with HIPAA and applicable laws
- Support Claims, Utilization Management, Intake, Quality, Care Management, and Patient Engagement departments
- Answer inquiries about benefits, claims, eligibility, provider networks, prior authorizations, preventive health, and healthcare topics
- Research, resolve, document, and follow up on complex Customer issues; escalate recurring issues and trends
- Educate Customers on plan benefits, policies, procedures, self-service portals, 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 checks, preventive care reminders, gap-in-care closure, and wellness check-ins
- Handle inbound inquiries from prospective enrollees and guide them through program enrollment
- Follow scripts, talking points, call flows, dialer workflows, calling regulations, and disclosure standards
- Recognize and escalate clinical, behavioral health, and urgent member needs
- 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
- Exceptional demonstrated customer service skills
- Strong empathy, patience, rapport-building, persuasion, objection-handling, problem-solving, and critical-thinking abilities
- Excellent English verbal and written communication, grammar, and pronunciation
- Comfort with structured outbound calling, scripted call flows, and dialer-based workflows
- 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 high accountability
- 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
- Employees must 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 your 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 equipment provided at no charge to the employee
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