Medical Contact Center Representative – Inbound/Outbound

Job not on LinkedIn

🔥 0 minutes ago

🏈 Ohio – Remote

🏈 Ohio – 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 and patience, build rapport, and establish trust • Help Customers navigate healthcare processes, benefits, care programs, internal processes, and available resources • Answer inquiries about benefits, claims, eligibility, provider networks, prior authorizations, preventive health promotion, and other healthcare topics • Research, resolve, document, and follow up on complex Customer issues, escalating recurring issues and trends to management • 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 calls from prospective enrollees, qualify interest, explain program value, 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 • Comply with TCPA, state do-not-call rules, HIPAA, and company policies • Support Claims, Utilization Management, 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 continuous improvement initiatives

🎯 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 demonstrated customer service skills and passion for helping others • Strong empathy, patience, rapport-building, 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 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 and calmly • Knowledge of medical terminology, healthcare benefits, and insurance processes • Ability to protect PHI and comply with HIPAA and applicable laws and regulations • Ability to work with multiple communication channels • Bilingual skills are a plus • Associate's, bachelor's, or master’s degree preferred

🏖️ 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 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 • Bi-weekly pay • Flexible work arrangement reducing commute time