Medical Contact Center Representative – Inbound and Outbound

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

📋 Description

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

• Actively engage in listening, show empathy and patience, foster rapport, build trust, and provide tailored customer experiences.

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

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

• Investigate, resolve, document, and follow up on complex customer issues, while escalating recurring problems and trends to management.

• Inform customers about 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, including medication refill reminders, blood pressure checks, preventive care reminders, gap-in-care closure, and wellness check-ins.

• Manage inbound inquiries from potential enrollees and guide them through the enrollment process.

• Articulate program value, features, and benefits; address hesitations and objections with empathy.

• Adhere to approved scripts, talking points, and call flows while customizing communication for each member.

• Operate dialer-based outbound workflows, manage call outcomes, and achieve productivity and quality targets.

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

• Comply with TCPA, state do-not-call regulations, HIPAA, company policies, and other relevant laws.

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

• Achieve targets for customer satisfaction, first contact resolution, quality, efficiency, attendance, and adherence to schedules.

• Engage in training and development while contributing ideas for improvements.

⛳️ Requirements

• High school diploma or equivalent is required.

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

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

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

• Strong abilities in empathy, patience, rapport-building, active listening, persuasion, objection handling, problem-solving, and critical thinking.

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

• Proficient in clear, concise, and professional communication.

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

• Ability to manage refusals, voicemails, unanswered calls, and a high volume of repetitive dialing in a professional manner.

• Capable of navigating complex systems and processes.

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

• Quick learner with the ability to retain information effectively.

• Able to work independently and collaboratively within a team, maintaining a high level of accountability.

• Competent in handling stressful situations with professionalism and composure.

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

• Bilingual skills are an advantage.

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

• Capability to provide an internet connection with at least 100 Mbps download and 10 Mbps upload speeds.

🏝️ Benefits

• Fully remote work / work from home.

• Required equipment provided at no cost to the employee.

• Medical, dental, and vision insurance plans.

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

• Life and disability insurance options.

• Voluntary life insurance choices available.

• Employee Assistance Program (EAP).

• Paid time off plans.

• Paid parental leave.

• Learning and development resources.

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