Medical Contact Center Representative – Inbound and Outbound

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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 actively, demonstrate empathy and patience, build rapport, establish trust, and deliver personalized customer experiences • Help customers navigate internal processes, resources, healthcare benefits, and care management 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, escalating recurring issues and trends to management • 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 inquiries from prospective enrollees and guide them through program enrollment steps • Explain program value, features, and benefits; address hesitation and objections with empathy • Follow approved scripts, talking points, and call flows while adapting communication to each member • Operate dialer-based outbound workflows, manage call dispositions, and meet productivity and quality targets • Escalate clinical, behavioral health, and urgent member concerns appropriately • Comply with TCPA, state do-not-call rules, HIPAA, company policies, and applicable regulations • Support departments including Claims, Utilization Management, Intake, Quality, Care Management, and Patient Engagement • Meet goals for customer satisfaction, first contact resolution, quality, efficiency, attendance, and schedule adherence • Participate in training and development and contribute improvement ideas

🎯 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 • Exceptional customer service skills and passion for helping others • Strong empathy, patience, rapport-building, active listening, persuasion, objection-handling, problem-solving, and critical-thinking skills • Excellent verbal and written communication, grammar, and English pronunciation • Ability to communicate clearly, concisely, and professionally • Comfort with structured outbound calling, scripted call flows, and dialer-based workflows • Ability to handle refusals, voicemails, unanswered calls, and repetitive dialing volume professionally • 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 a high level of accountability • Ability to handle stressful situations with professionalism and composure • 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

• Fully remote work / work from home • Necessary equipment provided at no charge to the employee • Medical, dental, and vision plans • 401(k) plan with a 3% employer match to a 6% employee contribution • Life and disability insurance • Voluntary life insurance options • Employee Assistance Program (EAP) • Paid time off plans • Paid parental leave • Learning and development resources • Full-time employees working 30 or more hours per week are eligible for the comprehensive benefits package