Healthcare Contact Center Representative – Inbound and Outbound

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

📋 Description

• Deliver friendly, precise, and prompt service to members/patients, providers, and other stakeholders via inbound and outbound phone, email, chat, SMS, video, co-browsing, and various other channels.

• Attune to customer needs, exhibit empathy, build rapport, and cultivate trust.

• Assist customers in navigating healthcare processes, benefits, care programs, and available resources.

• Address and resolve inquiries regarding benefits, claims, eligibility, provider networks, prior authorizations, preventive health, and related subjects.

• Investigate complex issues, collaborate with various departments, escalate recurring problems and trends, and ensure thorough resolution.

• Accurately document customer interactions and resolutions in the appropriate systems.

• Inform customers about plan benefits, policies, procedures, self-service portals, and healthcare resources.

• Execute outbound enrollment outreach and clinical quality and wellness calls, including medication reminders, blood pressure checks, preventive care reminders, care-gap closure, and wellness check-ins.

• Manage inbound inquiries concerning care-management programs, gauge interest, clarify program value, and guide prospective enrollees through subsequent steps.

• Adhere to scripts and call flows, manage dialer dispositions, and achieve productivity and quality objectives.

• Identify and escalate clinical, behavioral health, and urgent member needs.

• Safeguard PHI and comply with HIPAA, TCPA, state do-not-call regulations, and other relevant requirements.

• Provide support for Claims, Utilization Management, Intake, Quality, Care Management, Patient Engagement, and other departments.

• Engage in coaching, training, professional development, and process enhancement.

• Meet performance objectives for CSAT, first-contact resolution, quality, efficiency, attendance, and schedule adherence.

⛳️ Requirements

• High school diploma or equivalent is mandatory.

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

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

• Experience in both inbound and outbound customer service through multiple channels is highly preferred.

• Outstanding customer service skills and a genuine passion for assisting others are essential.

• Strong empathy, patience, rapport-building, active listening, persuasion, and objection-handling abilities are required.

• Exceptional English verbal and written communication skills, including grammar and pronunciation, are necessary.

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

• Strong problem-solving and critical-thinking skills are a must.

• Ability to navigate intricate systems and processes is essential.

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

• Capability to learn and retain information swiftly is necessary.

• Ability to work both independently and collaboratively with a strong sense of accountability is essential.

• Capacity to manage stressful situations professionally and calmly is required.

• Knowledge of medical terminology, healthcare benefits, and insurance processes is beneficial.

• Bilingual abilities are an advantage.

• An associate's, bachelor's, or master's degree is preferred.

• Must provide internet with a minimum of 100 Mbps download and 10 Mbps upload speeds.

🏝️ Benefits

• Fully remote work with flexibility and no commuting required.

• Comprehensive medical, dental, and vision plans.

• 401(k) plan with a 3% employer match on the employee's 6% contribution.

• Life and disability insurance coverage.

• Options for voluntary life insurance.

• Employee Assistance Program (EAP) available.

• Paid time off plans offered.

• Paid parental leave benefits.

• Access to learning and development resources.

• Necessary work equipment provided at no cost.

• Virtual meetings with cameras on to encourage connection and engagement.