Customer Engagement Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Deliver friendly, precise, and prompt service to Customers (members/patients, providers, and other stakeholders) through various communication channels including inbound and outbound interactions via phone, email, chat, SMS, video calls, co-browser sessions, and more.

• Actively engage in listening to comprehend Customers’ needs and concerns, demonstrating empathy and patience.

• Assist Customers in navigating internal processes and available resources to help them achieve their desired outcomes.

• Foster rapport and build trust with Customers to ensure a positive and personalized experience.

• Exceed Customer expectations by going the extra mile, leaving a lasting positive impression.

• Safeguard Customers’ privacy, dignity, and Personal Health Information (PHI) at all times while adhering to HIPAA and all relevant laws and regulations.

• Provide backup and support to other departments (e.g., Claims, UM, Intake, Quality, Care Management, Patient Engagement) and carry out various other tasks as assigned.

• Resolution and Problem Solving: Address inquiries regarding benefits, claims, eligibility, provider networks, prior authorizations, preventative health promotion, and other healthcare-related subjects.

• Investigate and resolve complex issues, collaborating with other departments as needed (e.g., Claims, Provider Relations, Utilization Management, Intake, Care Management, Quality, etc.).

• Take ownership of Customer concerns, ensuring complete resolution and satisfaction through follow-up.

• Proactively identify and escalate recurring issues or trends to management.

• Accurately and thoroughly document all interactions and resolutions in the appropriate systems.

• Healthcare Consumer Education: Inform Customers about plan benefits, policies, and procedures.

• Clearly explain intricate healthcare information in an easily understandable manner.

• Promote the use of our self-service portal and effectively instruct Customers on how to navigate and utilize our portal and other resources.

• Empower Customers with the knowledge necessary to make informed decisions about their health and benefits.

• Outbound Outreach and Program Enrollment: Perform outbound enrollment outreach, inviting eligible members/patients to participate in Guidehealth’s care management and care coordination programs.

• Conduct outbound clinical quality and wellness outreach, including medication refill reminders, blood pressure check-ins, preventive care alerts, gap-in-care closure, and general wellness check-ins.

• Manage inbound calls from prospective enrollees inquiring about Guidehealth’s care management programs, qualifying interest, and guiding them through the next steps.

• Clearly convey the value, features, and benefits of our programs in customer-friendly language, helping Customers understand how participation aligns with their health goals.

• Utilize consultative listening and persuasion skills to address hesitations, answer questions, and alleviate common objections with empathy, patience, and respect for the Customer’s choices.

• Follow approved scripts, talking points, and call flows while adjusting tone and pacing to suit each individual member.

• Recognize and appropriately escalate clinical and behavioral health concerns, as well as urgent member needs, identified during Customer interactions.

• Adhere to all applicable outbound calling regulations and policies, including TCPA, state do-not-call rules, and Guidehealth scripting and disclosure standards. (Note: Customer Guides do not complete sales transactions or collect payments; the focus is on enrollment, education, and customer engagement.)

• Compliance and Quality: Actively seek and accept coaching, feedback, and professional development opportunities from peers, Customer Guide Coaches, Trainers, and Managers.

• Abide by all company policies, procedures, and regulatory requirements (e.g., HIPAA).

⛳️ Requirements

• High school diploma or equivalent is required.

• At least 2 years of experience in one or more of the following: 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.

• Candidates with experience in both inbound and outbound Customer service across multiple channels are strongly preferred.

• Minimum of 1 year of experience in a healthcare contact center or outbound calling environment.

• Exceptional customer service skills, with a genuine enthusiasm for assisting others.

• Strong empathy, patience, and the ability to establish rapport with diverse individuals.

• Excellent verbal and written communication skills, including proper grammar and pronunciation in the English language.

• Ability to communicate clearly, concisely, and professionally.

• Active listening skills with the capacity to understand and effectively address customer needs.

• Strong persuasion and objection-handling abilities, with the skill to articulate the value of programs and services in a clear, customer-focused manner (note: this role does not involve closing sales transactions or collecting payments).

• Comfort with structured outbound calling, scripted call flows, and dialer-based workflows.

• Resilience and a positive, professional demeanor when handling refusals, voicemails, unanswered calls, and repetitive dialing volume.

• Strong problem-solving and critical-thinking skills.

• Ability to navigate complex systems and processes.

• Proficiency with computer systems, including CRM software and Microsoft Office Suite.

• Ability to learn and retain information quickly.

• Capability to work independently as well as part of a team; must demonstrate a high level of accountability for your work and in support of the team and the business.

• Ability to manage stressful situations with professionalism and composure.

• Familiarity with medical terminology, healthcare benefits, and insurance processes.

🏝️ Benefits

• Work from Home: Guidehealth operates as a fully remote company, allowing you the flexibility to minimize commuting time and focus more on your professional goals and personal needs.

• Keep Health a Priority: We provide comprehensive Medical, Dental, and Vision plans to ensure you are well covered.

• Plan for the Future: Our 401(k) plan features a 3% employer match on your 6% contribution.

• Have Peace of Mind: We offer Life and Disability insurance for those unexpected moments, along with voluntary Life options for additional protection for you and your loved ones.

• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is available to assist you during challenging times.

• Take Time for Yourself: We provide paid time off plans to help you maintain a balance between work and personal goals.

• Support Your New Family: Guidehealth offers paid parental leave to ensure you have the time you need.

• Learn and Grow: Your professional development is important to us. Guidehealth provides various resources dedicated to your learning and growth to help advance your career with us.