Customer Engagement Specialist

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🕒 Julho 24

🤠 Texas – Remoto

🤠 Texas – Remote

💵 $20 - $22 / hora

⏰ Tempo Integral

🟢 Júnior

🟡 Pleno

🏆 Sucesso do Cliente

🚫👨‍🎓 Sem graduação necessária

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Guide Healthcare

SiteLinkedInTodas as Vagas

51 - 200 funcionários

Fundada em 2018

⚕️ Seguro de Saúde

🏥 Saúde

🎯 Recrutamento

Healthcare Insurance • Healthcare • Recruitment

A Guide Healthcare está liderando um movimento onde a criatividade gera mudanças positivas no setor de saúde. A empresa é especializada na prestação de serviços de saúde aliados e recrutamento na área de saúde, com foco no suporte e tratamento de idosos. Com um compromisso de agregar valor aos seus clientes, parceiros e equipes, a Guide Healthcare busca fazer as coisas de maneira diferente na indústria.

Descrição

• Provide friendly, accurate, and timely service to Customers (members/patients, providers, and other stakeholders) through inbound and outbound interactions via phone, email, chat, SMS, video calls, co-browser sessions, and other communication channels. • Actively listen to understand Customers’ needs and concerns and demonstrate empathy and patience. • Help Customers navigate internal processes and available resources to achieve their desired results. • Build rapport and establish trust with Customers to create a positive, personalized experience. • Go above and beyond to exceed Customer expectations and leave a lasting positive impression. • Protect Customers’ privacy, dignity, and Personal Health Information (PHI) at all times and comply with HIPAA and all applicable laws and regulations. • Backup and support other departments (i.e., Claims, UM, Intake, Quality, Care Management, Patient Engagement) and perform a variety of other duties as assigned. • Issue Resolution and Problem Solving: Answer inquiries regarding benefits, claims, eligibility, provider networks, prior authorizations, preventative health promotion, and other healthcare-related topics. • Research and resolve complex issues, collaborating with other departments as needed (e.g., Claims, Provider Relations, Utilization Management, Intake, Care Management, Quality, etc.). • Take ownership of Customer issues, following through to ensure complete resolution and satisfaction. • Proactively identify and escalate recurring issues or trends to management. • Document all interactions and resolutions accurately and thoroughly in the appropriate systems. • Research and solve Customer issues and reply to Customer inquiries with friendly, accurate, and timely resolutions. • Healthcare Consumer Education: Educate Customers on plan benefits, policies, and procedures. • Clearly and concisely explain complex healthcare information in a way that is easy to understand. • Encourage the use of our self-service portal and effectively teach Customers how to navigate and use our portal and other available resources. • Empower Customers with the knowledge they need to make informed decisions about their health and benefits. • Outbound Outreach and Program Enrollment: Conduct outbound enrollment outreach, inviting eligible members/patients to join Guidehealth’s care management and care coordination programs. • Conduct outbound clinical quality and wellness outreach, including medication refill reminders, blood pressure check-ins, preventive care reminders, gap-in-care closure, and general wellness check-ins. • Handle inbound calls from prospective enrollees inquiring about Guidehealth’s care management programs, qualifying interest and guiding them through next steps. • Clearly articulate the value, features, and benefits of our programs in plain, customer-centered language, helping Customers understand how participation supports their health goals. • Apply consultative listening and persuasion skills to address hesitation, answer questions, and overcome common objections with empathy, patience, and respect for the Customer’s decision. • Follow approved scripts, talking points, and call flows while adapting tone and pacing to each individual member. • Operate effectively within dialer-based outbound workflows, manage call dispositions accurately, and meet outreach productivity and quality targets. • Recognize and appropriately escalate clinical and behavioral health concerns, as well as urgent member needs, identified during Customer interactions. • Comply with all applicable outbound calling regulations and policies, including TCPA, state do-not-call rules, and Guidehealth scripting and disclosure standards. (Note: Customer Guides do not close sales transactions or collect payments; the focus is enrollment, education, and customer engagement.) • Compliance and Quality: Actively seek and accept coaching, feedback, and opportunities for professional development from peers, Customer Guide Coaches, Trainers, and Managers. • Adhere to all company policies, procedures, and regulatory requirements (e.g., HIPAA). • Maintain confidentiality and protect sensitive member information. • Meet or exceed individual and team performance goals related to Customer satisfaction (CSAT), first contact resolution, quality, efficiency, attendance, and schedule adherence. • Participate in ongoing training and development to enhance skills and knowledge. Contribute thoughtful ideas and suggestions for improvement and promote a positive and collaborative team environment.

🎯 Requisitos

• High school diploma or equivalent required. • Minimum of 2 years of experience in one or more of the following: 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. • Candidates with experience in both inbound and outbound Customer service via multiple channels are strongly preferred. • Minimum of 1 year of experience in a healthcare contact center or outbound calling environment. • Exceptional, demonstrated customer service skills, with a genuine passion for helping others. • Strong empathy, patience, and the ability to build rapport with diverse individuals. • Excellent verbal and written communication skills, excellent grammar, and pronunciation in the English language. • Ability to communicate clearly, concisely, and professionally. • Active listening skills and the ability to understand and address customer needs effectively. • Strong persuasion and objection-handling skills, with the ability to articulate the value of programs and services in a clear, Customer-centered way (note: this role does not involve closing sales transactions or collecting payment). • Comfort with structured outbound calling, scripted call flows, and dialer-based workflows. • Resilience and a positive, professional attitude when navigating 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, including CRM software and Microsoft Office Suite. • Ability to learn and retain information quickly. • Ability to work independently and as part of a team; must possess a high level of accountability for your work and in support of the team and the business. • Ability to handle stressful situations with professionalism and composure. • Knowledge of medical terminology, healthcare benefits, and insurance processes.

🏖️ Benefícios

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs. • Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered. • Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution. • Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected. • Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times. • Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals. • Support Your New Family: Guidehealth offers paid parental leave to give you the time you need. • Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.