Medical Contact Center Representative, Inbound/Outbound
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Job Description
Medical contact center representative supporting Guidehealth’s data-powered healthcare services. Guiding patients through benefits, care programs, enrollment, and wellness outreach via multiple communication channels.
Responsibilities:
- Provide friendly, accurate, and timely service to members/patients, providers, and other stakeholders 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, build rapport, and establish trust
- Help Customers navigate internal processes, benefits, care programs, and available resources
- Protect privacy, dignity, and PHI while complying with HIPAA and applicable laws and regulations
- Support departments including Claims, Utilization Management, Intake, Quality, Care Management, and Patient Engagement
- Answer inquiries about benefits, claims, eligibility, provider networks, prior authorizations, preventive health promotion, and healthcare topics
- Research, resolve, document, and follow up on complex Customer issues; escalate recurring issues and trends
- 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 check-ins, preventive care reminders, gap-in-care closure, and wellness check-ins
- Handle inbound inquiries from prospective enrollees and guide them through next steps
- Explain program value, features, and benefits; address hesitation and objections using approved scripts and call flows
- Operate dialer-based outbound workflows, manage call dispositions, and meet outreach productivity and quality targets
- Escalate clinical, behavioral health, and urgent member needs appropriately
- Meet performance goals for CSAT, first contact resolution, quality, efficiency, attendance, and schedule adherence
- Participate in training, coaching, professional development, and process improvement initiatives
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 and passion for helping others
- Strong empathy, patience, rapport-building, active listening, problem-solving, and critical-thinking skills
- Excellent verbal and written communication, grammar, and pronunciation in English
- Strong persuasion and objection-handling skills
- 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
- Must provide an internet connection with minimum 100 Mbps download and 10 Mbps upload, capable of video calls and system connectivity
- Bilingual skills are a plus
- Associate's, bachelor's, or master’s degree preferred
Benefits:
- Fully remote work arrangement
- 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 work equipment provided at no charge to the employee
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