Medical Contact Center Representative – Inbound and Outbound

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🔥 0 minutes ago

🦌 Connecticut – Remote

🦌 Connecticut – Remote

💵 $20 - $22 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

📞 Call Center Representative

🚫👨‍🎓 No degree required

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Guide Healthcare

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2018

⚕️ Healthcare Insurance

🏥 Healthcare

🎯 Recruiter

Healthcare Insurance • Healthcare • Recruitment

Guide Healthcare is leading a movement where creativity delivers positive change in the healthcare sector. The company specializes in allied health service provision and healthcare recruitment, focusing on the support and treatment of older adults. With a commitment to adding value to their clients, partners, and teams, Guide Healthcare aims to do things differently in the industry.

📋 Description

• 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 to Customers’ needs and concerns, demonstrate empathy, build rapport, and establish trust • Help Customers navigate internal processes, resources, healthcare benefits, and care programs • Answer inquiries about benefits, claims, eligibility, provider networks, prior authorizations, preventive health promotion, and healthcare topics • Research, resolve, document, and follow through on complex Customer issues; escalate recurring issues and trends • 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 inquiries from prospective enrollees, qualify interest, explain program value and benefits, and guide next steps • Use approved scripts, talking points, call flows, and dialer-based workflows; manage call dispositions and meet productivity and quality targets • Escalate clinical, behavioral health, and urgent member concerns appropriately • Support Claims, Utilization Management, Intake, Quality, Care Management, and Patient Engagement departments • Protect PHI and comply with HIPAA, TCPA, state do-not-call rules, company policies, and applicable regulations • 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 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 • Strong empathy, patience, rapport-building, persuasion, and objection-handling skills • Excellent verbal and written communication, grammar, and English pronunciation • Active listening and customer-needs assessment skills • Comfort with structured outbound calling, scripted call flows, and dialer-based workflows • Resilience when handling 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, CRM software, and Microsoft Office Suite • Ability to learn and retain information quickly • Ability to work independently and as part of a team • High accountability and ability to handle stressful situations professionally • Knowledge of medical terminology, healthcare benefits, and insurance processes • Experience with inbound and outbound customer service through multiple channels strongly preferred • Bilingual skills a plus • Associate’s, bachelor’s, or master’s degree preferred • Ability to provide internet with minimum 100 Mbps download and 10 Mbps upload • Must be accessible during stated working hours and participate in virtual meetings with cameras on

🏖️ Benefits

• Work from home / fully remote work • Medical insurance • Dental insurance • Vision insurance • 401(k) plan with a 3% employer match to the employee’s 6% contribution • Life insurance • 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 • Full-time employees working 30 hours per week or more eligible for comprehensive benefits