Medical Contact Center Representative – Inbound and Outbound

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

📋 Description

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

• Attend to Customers' needs with empathy and patience, fostering rapport and building trust.

• Assist Customers in navigating healthcare processes, benefits, care programs, internal resources, and self-service portals.

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

• Investigate, resolve, document, and follow up on intricate Customer issues; escalate persistent problems and trends as needed.

• Educate Customers about plan benefits, policies, procedures, and healthcare information.

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

• Perform clinical quality and wellness outreach, which includes 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 interest, explain program benefits, and guide next steps.

• Utilize approved scripts, call flows, dialer workflows, and accurate call dispositions while meeting productivity and quality benchmarks.

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

• Adhere to HIPAA, TCPA, state do-not-call regulations, scripting standards, and other relevant compliance requirements.

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

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

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

⛳️ Requirements

• High school diploma or equivalent is mandatory.

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

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

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

• Outstanding customer service abilities.

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

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

• Proficient in persuasion and objection-handling techniques.

• Comfortable with structured outbound calling, scripted call flows, and dialer-based processes.

• Strong problem-solving and critical-thinking skills.

• Capability to navigate complex systems and processes.

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

• Quick learner with the ability to retain information efficiently.

• Able to work independently as well as collaboratively in a team environment.

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

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

• Bilingual abilities are a plus.

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

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

🏝️ Benefits

• Work from home / fully remote employment.

• Comprehensive Medical, Dental, and Vision insurance plans.

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

• Life and Disability insurance options.

• Voluntary Life insurance options available.

• Employee Assistance Program (EAP).

• Paid time off plans.

• Paid parental leave.

• Access to learning and development resources.

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