Medical Contact Center Representative, Inbound/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, and establish trust with Customers • Help Customers navigate internal processes, resources, healthcare benefits, and care programs • Protect Customer privacy, dignity, and PHI while complying with HIPAA and applicable laws • Support Claims, Utilization Management, Intake, Quality, Care Management, and Patient Engagement departments • Answer and resolve inquiries about benefits, claims, eligibility, provider networks, prior authorizations, preventive health, and other healthcare topics • Research complex issues, collaborate with other departments, document interactions, and escalate recurring issues or trends • Educate Customers on plan benefits, policies, procedures, self-service portals, and available resources • Conduct outbound enrollment, clinical quality, medication refill, blood pressure, preventive care, gap-in-care, and wellness outreach • Handle inbound program inquiries, qualify interest, explain program value, and guide prospective enrollees through next steps • Follow approved scripts, call flows, disclosures, TCPA requirements, and state do-not-call rules • Recognize and escalate clinical, behavioral health, and urgent member needs • Meet Customer satisfaction, first-contact resolution, quality, efficiency, attendance, and schedule-adherence goals • Participate in coaching, training, 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, active listening, problem-solving, and critical-thinking abilities • 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 • 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 • Bilingual skills are a plus • Associate's, bachelor's, or master's degree preferred • Employees must provide internet capable of video calls and internal/external systems, with minimum 100 Mbps download and 10 Mbps upload • Employees must be accessible during stated working hours and participate in virtual meetings with cameras on

🏖️ Benefits

• Fully remote work • 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 • Necessary work equipment provided at no charge • Equal opportunity employment