Healthcare Contact Center Representative – Inbound and Outbound

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

📋 Description

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

• Attentively address Customers' needs and concerns, showcasing empathy and patience, while building rapport and establishing trust.

• Assist Customers in navigating healthcare benefits, care management programs, internal processes, and available resources.

• Safeguard Customer privacy, dignity, and PHI in compliance with HIPAA and relevant laws and regulations.

• Respond to and resolve inquiries regarding benefits, claims, eligibility, provider networks, prior authorizations, preventive health, and other healthcare topics.

• Investigate complex issues, collaborate with Claims, Provider Relations, Utilization Management, Intake, Care Management, Quality, and other departments, and escalate recurring issues or trends as necessary.

• Accurately document interactions and resolutions in the appropriate systems.

• Educate Customers on plan benefits, policies, procedures, self-service portals, and healthcare information.

• Conduct outbound outreach for enrollment, clinical quality, wellness, medication refills, blood pressure monitoring, preventive care, and addressing care gaps.

• Manage inbound calls from prospective enrollees, guiding them through the care management program enrollment process.

• Articulate program value, features, and benefits while addressing hesitation and objections with empathy.

• Adhere to approved scripts, talking points, call flows, dialing workflows, dispositions, and outreach regulations.

• Appropriately escalate clinical, behavioral health, and urgent member concerns.

• Achieve goals related to Customer satisfaction, first-contact resolution, quality, efficiency, attendance, and schedule adherence.

• Engage in training, coaching, professional development, and continuous improvement initiatives.

• Support other departments and undertake additional responsibilities as assigned.

⛳️ Requirements

• High school diploma or equivalent is required.

• A minimum of 2 years of experience in customer service within a health plan, HMO, TPA, or healthcare setting; or roles in program enrollment, telemarketing, cold calling, appointment setting, inside sales, or other outbound calling positions.

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

• Exceptional customer service skills with a strong passion for assisting others.

• Strong empathy, patience, rapport-building, active listening, persuasion, and objection-handling skills.

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

• Comfortable with structured outbound calling, following scripted call flows, and utilizing dialer-based workflows.

• Strong problem-solving and critical-thinking skills.

• Ability to navigate complex systems and processes effectively.

• Proficiency in computer systems, CRM software, and the Microsoft Office Suite.

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

• Capability to work independently as well as part of a team.

• Ability to manage stressful situations in a professional and composed manner.

• Quick learning and information retention abilities.

• Bilingual skills are advantageous; an associate's, bachelor's, or master's degree is preferred.

• Must provide an internet connection with a minimum of 100 Mbps download and 10 Mbps upload speed.

🏝️ Benefits

• Work from home with full remote flexibility.

• 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.

• Access to learning and development resources.

• Necessary work equipment provided at no cost to the employee.