Medical Contact Center Representative – Inbound and Outbound

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🔥 0 minutes ago

🤠 Texas – Remote

🤠 Texas – 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, and co-browser sessions • Listen to Customers' needs, demonstrate empathy and patience, build rapport, and establish trust • Help Customers navigate healthcare processes, benefits, care programs, internal resources, and self-service portals • Answer inquiries about benefits, claims, eligibility, provider networks, prior authorizations, preventive health promotion, and other healthcare topics • Research, resolve, document, and follow through on complex Customer issues; escalate recurring issues and trends • Educate Customers on plan benefits, policies, procedures, and healthcare information • 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 guide next steps • Use approved scripts, call flows, dialer workflows, and accurate call dispositions while meeting productivity and quality targets • Escalate clinical, behavioral health, and urgent member needs appropriately • Comply with HIPAA, TCPA, state do-not-call rules, scripting standards, and other applicable regulations • Support Claims, UM, Intake, Quality, Care Management, and Patient Engagement departments • 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 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 • Experience in both inbound and outbound Customer service via multiple channels strongly preferred • Exceptional customer service skills • Strong empathy, patience, rapport-building, and active listening skills • Excellent verbal and written English communication, grammar, and pronunciation • Strong persuasion and objection-handling skills • Comfort with structured outbound calling, scripted call flows, and dialer-based workflows • 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 • Ability to handle stressful situations professionally and calmly • Knowledge of medical terminology, healthcare benefits, and insurance processes • 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 • 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 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