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 empathetically, build rapport, establish trust, and create personalized customer experiences • Help customers navigate healthcare processes, resources, benefits, and care programs • Answer and resolve inquiries about benefits, claims, eligibility, provider networks, prior authorizations, preventive health, and related topics • Research complex issues, collaborate with Claims, Provider Relations, Utilization Management, Intake, Care Management, Quality, and other departments, and escalate recurring issues or urgent concerns • Document customer interactions and resolutions accurately in appropriate systems • Educate customers on 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 check-ins, preventive care reminders, gap-in-care closure, and wellness check-ins • Handle inbound program inquiries, qualify interest, explain program value, and guide prospective enrollees through next steps • Follow approved scripts, talking points, call flows, outbound calling regulations, and disclosure standards • Operate dialer-based outbound workflows, manage dispositions, and meet outreach productivity and quality targets • Protect PHI and customer privacy while complying with HIPAA and applicable laws • Meet customer satisfaction, first-contact resolution, quality, efficiency, attendance, and schedule-adherence goals • Participate in training, coaching, professional development, cross-training, and process improvement initiatives • Support other departments and perform other assigned duties

🎯 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, persuasion, objection-handling, problem-solving, and critical-thinking skills • Excellent verbal and written communication, grammar, and pronunciation in English • 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 strong 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, TCPA, state do-not-call rules, and applicable laws • Bilingual skills are a plus • Associate's, bachelor's, or master's degree preferred

🏖️ Benefits

• Work from Home / fully remote work • Necessary 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 • Virtual meetings with cameras on • Full-time employees working 30 or more hours per week are eligible for the comprehensive benefits package