Medical Contact Center Representative – Inbound and Outbound

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

📋 Description

• Deliver courteous, precise, and prompt assistance to members/patients, providers, and stakeholders via inbound and outbound phone calls, emails, chats, SMS, video calls, co-browser sessions, and various other communication channels.

• Attentively respond to customer needs, exhibit empathy and patience, foster rapport, and build trust.

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

• Safeguard customer privacy and PHI while adhering to HIPAA regulations and relevant laws.

• Provide support to departments such as Claims, Utilization Management, Intake, Quality, Care Management, and Patient Engagement.

• Address inquiries regarding benefits, claims, eligibility, provider networks, prior authorizations, preventive health, and healthcare-related topics.

• Investigate, resolve, document, and follow up on complex customer issues; escalate recurring problems and critical clinical or behavioral health matters.

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

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

• Conduct clinical quality and wellness outreach, which includes medication refill reminders, blood pressure checks, preventive care alerts, gap-in-care closure, and wellness check-ins.

• Manage inbound program inquiries, assess interest, articulate program value, and guide prospective enrollees through the next steps.

• Utilize approved scripts, talking points, call flows, and dialer workflows; manage call dispositions and achieve productivity and quality objectives.

• Adhere to TCPA regulations, state do-not-call guidelines, scripting, and disclosure standards.

• Meet or surpass targets for CSAT, first-contact resolution, quality, efficiency, attendance, and schedule compliance.

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

⛳️ Requirements

• A high school diploma or equivalent is required.

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

• A minimum of 1 year of experience in a healthcare contact center or outbound calling situation.

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

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

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

• Ability to communicate in a clear, concise, and professional manner.

• Proficient active listening and effective customer needs assessment skills.

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

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

• Strong problem-solving and critical thinking skills.

• Capability to navigate complex systems and processes.

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

• Ability to learn and retain information swiftly.

• Capacity to work independently and collaboratively within a team, demonstrating strong accountability.

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

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

• Preference given to candidates with experience in inbound and outbound customer service across various channels.

• Bilingual skills are advantageous.

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

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

🏝️ Benefits

• Work from Home / fully remote work.

• Medical, Dental, and Vision plans.

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

• Life and Disability insurance.

• Voluntary Life insurance options available.

• Employee Assistance Program (EAP).

• Paid time off plans.

• Paid parental leave.

• Learning and development resources.

• Required work equipment provided at no cost.

• Flexible remote work arrangement.

• Comprehensive benefits package for full-time employees working 30 hours per week or more.