Medical Contact Center Representative – Inbound/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 customer needs, demonstrate empathy, build rapport, and establish trust • Help customers navigate healthcare processes, benefits, care programs, and available resources • Protect customer privacy, dignity, PHI, and confidential member information while complying with HIPAA and applicable regulations • Answer and resolve inquiries about benefits, claims, eligibility, provider networks, prior authorizations, preventive health, and other healthcare topics • Research complex issues, collaborate with Claims, Provider Relations, Utilization Management, Intake, Care Management, Quality, and other departments, and escalate recurring issues or trends • Document customer interactions and resolutions accurately in appropriate systems • Educate customers on plan benefits, policies, procedures, self-service portals, 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 and guide them through program enrollment steps • Use approved scripts, talking points, call flows, and dialer workflows; accurately manage call dispositions and meet productivity and quality targets • Recognize and escalate clinical, behavioral health, and urgent member needs • Comply with outbound calling regulations, TCPA, state do-not-call rules, scripting, and disclosure standards • Meet or exceed goals for customer satisfaction, first-contact resolution, quality, efficiency, attendance, and schedule adherence • Participate in training, accept coaching, contribute improvement ideas, and support a positive collaborative environment • Provide backup support to other departments and perform additional duties as assigned

🎯 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 with inbound and outbound customer service via multiple channels strongly preferred • Exceptional customer service skills and passion for helping others • Strong empathy, patience, rapport-building, active listening, and problem-solving skills • Excellent verbal and written communication, grammar, and pronunciation in English • Strong persuasion and objection-handling skills • Comfort with structured outbound calling, scripted call flows, and dialer-based workflows • Resilience and professional composure when handling refusals, voicemails, unanswered calls, and repetitive dialing volume • 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 high accountability • Ability to handle stressful situations professionally • 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 • Employees must be accessible during stated working hours and join virtual meetings with cameras on

🏖️ Benefits

• Fully remote work arrangement • Necessary work equipment provided at no charge to the employee • 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 insurance options • Employee Assistance Program (EAP) • Paid time off plans • Paid parental leave • Learning and development resources • Comprehensive benefits package for full-time employees working 30 hours per week or more