Medical Contact Center Representative – Inbound and Outbound

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

📋 Description

• Deliver friendly, precise, and prompt service to members/patients, providers, and various stakeholders through multiple channels including inbound and outbound calls, emails, chats, SMS, video calls, co-browsing sessions, and more.

• Understand and respond to customers’ needs and concerns with empathy, fostering rapport and trust.

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

• Address questions related to benefits, claims, eligibility, provider networks, prior authorizations, preventive health promotion, and other healthcare topics.

• Investigate, resolve, document, and follow up on complex customer issues; escalate recurring problems and trends as needed.

• Educate customers on plan benefits, policies, procedures, self-service portals, and available resources.

• Conduct outbound enrollment outreach for care management and coordination programs.

• Perform clinical quality and wellness outreach activities, such as medication refill reminders, blood pressure check-ins, preventive care reminders, gap-in-care closures, and wellness check-ins.

• Manage inbound inquiries from potential enrollees, assess their interest, explain program value and benefits, and guide them on next steps.

• Utilize approved scripts, talking points, call flows, and dialer-based workflows; manage call outcomes while achieving productivity and quality goals.

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

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

• Safeguard PHI and comply with HIPAA, TCPA, state do-not-call regulations, company policies, and relevant laws.

• Achieve performance targets for customer satisfaction (CSAT), first contact resolution, quality, efficiency, attendance, and schedule adherence.

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

⛳️ Requirements

• High school diploma or equivalent is required.

• At least 2 years of customer service experience in a health plan, HMO, TPA, or healthcare setting, or in 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.

• Outstanding customer service skills.

• Strong empathy, patience, rapport-building, persuasion, and objection-handling abilities.

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

• Active listening and customer needs assessment capabilities.

• Comfort with structured outbound calls, scripted interactions, and dialer-based workflows.

• Resilience in managing refusals, voicemails, unanswered calls, and repetitive dialing volumes.

• Strong problem-solving and critical thinking skills.

• Ability to navigate complex systems and processes.

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

• Quick learning and information retention capabilities.

• Ability to work independently and collaboratively within a team.

• High accountability and professionalism in handling stressful situations.

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

• Experience in inbound and outbound customer service through various channels is strongly preferred.

• Bilingual skills are a plus.

• 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.

• Availability during designated working hours and participation in virtual meetings with cameras on is required.

🏝️ Benefits

• Work from home / fully remote work options.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

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

• Life insurance benefits.

• Disability insurance coverage.

• 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.

• Full-time employees working 30 hours per week or more are eligible for comprehensive benefits.