Medical Contact Center Representative – Inbound and Outbound

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🔥 0 minutes ago

🐎 Kentucky – Remote

🐎 Kentucky – 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 stakeholders through inbound and outbound phone, email, chat, SMS, video calls, co-browser sessions, and other channels • Listen to customer needs, demonstrate empathy and patience, build rapport, and establish trust • Help customers navigate healthcare processes, resources, benefits, and care programs • Protect customer privacy and PHI while complying with HIPAA and applicable laws • Support departments including Claims, Utilization Management, Intake, Quality, Care Management, and Patient Engagement • Answer questions about benefits, claims, eligibility, provider networks, prior authorizations, preventive health, and healthcare topics • Research, resolve, document, and follow through on complex customer issues; escalate recurring issues and urgent clinical or behavioral health concerns • 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 checks, 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 • Use approved scripts, talking points, call flows, and dialer workflows; manage call dispositions and meet productivity and quality targets • Comply with TCPA, state do-not-call rules, scripting, and disclosure standards • Meet or exceed 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 and passion for helping others • Strong empathy, patience, rapport-building, persuasion, and objection-handling skills • Excellent verbal and written communication, grammar, and pronunciation in English • Ability to communicate clearly, concisely, and professionally • Active listening and effective 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 with strong accountability • Ability to handle stressful situations professionally and calmly • Knowledge of medical terminology, healthcare benefits, and insurance processes • Candidates with inbound and outbound customer service experience across multiple channels strongly preferred • Bilingual skills are a plus • Associate's, bachelor's, or master's degree preferred • Ability to 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 a 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 • Necessary work equipment provided at no charge • Flexible remote work arrangement • Full-time employees working 30 hours per week or more are eligible for the comprehensive benefits package