Medical Contact Center Representative, Inbound/Outbound
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Job Description
Remote Medical Contact Center Representative serving Guidehealth members and providers. Handling healthcare inquiries, benefits education, enrollment outreach, and clinical wellness calls.
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 empathetically, build rapport, establish trust, and create personalized customer experiences
- Help customers navigate healthcare processes, resources, benefits, and care programs
- Answer and resolve inquiries about benefits, claims, eligibility, provider networks, prior authorizations, preventive health, and related topics
- Research complex issues, collaborate with Claims, Provider Relations, Utilization Management, Intake, Care Management, Quality, and other departments, and escalate recurring issues or urgent concerns
- Document customer interactions and resolutions accurately in appropriate systems
- 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 program inquiries, qualify interest, explain program value, and guide prospective enrollees through next steps
- Follow approved scripts, talking points, call flows, outbound calling regulations, and disclosure standards
- Operate dialer-based outbound workflows, manage dispositions, and meet outreach productivity and quality targets
- Protect PHI and customer privacy while complying with HIPAA and applicable laws
- Meet customer satisfaction, first-contact resolution, quality, efficiency, attendance, and schedule-adherence goals
- Participate in training, coaching, professional development, cross-training, and process improvement initiatives
- Support other departments and perform other assigned duties
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, objection-handling, problem-solving, and critical-thinking skills
- Excellent verbal and written communication, grammar, and pronunciation in English
- 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 strong accountability
- Ability to handle stressful situations professionally and calmly
- Knowledge of medical terminology, healthcare benefits, and insurance processes
- Ability to protect PHI and comply with HIPAA, TCPA, state do-not-call rules, and applicable laws
- Bilingual skills are a plus
- Associate's, bachelor's, or master's degree preferred
Benefits:
- Work from Home / fully remote work
- Necessary equipment provided at no charge to the employee
- 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 insurance options
- Employee Assistance Program (EAP)
- Paid time off plans
- Paid parental leave
- Learning and development resources
- Virtual meetings with cameras on
- Full-time employees working 30 or more hours per week are eligible for the comprehensive benefits package
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