Medical Contact Center Representative – Inbound/Outbound

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

📋 Description

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

• Understand customer needs, show empathy, develop rapport, and build trust.

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

• Safeguard customer privacy, dignity, PHI, and confidential member information while adhering to HIPAA and relevant regulations.

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

• Investigate complex issues, collaborate with Claims, Provider Relations, Utilization Management, Intake, Care Management, Quality, and other departments, and escalate recurring issues or trends as necessary.

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

• Educate customers about plan benefits, policies, procedures, self-service portals, and healthcare information.

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

• Perform clinical quality and wellness outreach, including medication refill reminders, blood pressure check-ins, preventive care reminders, gap-in-care closure, and wellness check-ins.

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

• Utilize approved scripts, talking points, call flows, and dialer workflows; accurately manage call dispositions while achieving productivity and quality targets.

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

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

• Achieve or surpass targets for customer satisfaction, first-contact resolution, quality, efficiency, attendance, and schedule adherence.

• Engage in training, accept coaching, contribute ideas for improvement, and support a positive collaborative atmosphere.

• Provide backup support to other departments and undertake additional responsibilities as needed.

⛳️ 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 related outbound calling roles.

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

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

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

• Strong empathy, patience, rapport-building, active listening, and problem-solving abilities.

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

• Proficient in persuasion and objection-handling techniques.

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

• Resilient and professionally composed when managing refusals, voicemails, unanswered calls, and high dialing volumes.

• Ability to navigate complex systems and processes effectively.

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

• Quick learner with the ability to retain information rapidly.

• Capable of working independently as well as collaboratively within a team, demonstrating high accountability.

• Professional demeanor when dealing with stressful situations.

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

• Bilingual skills are an advantage.

• 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.

• Employees should be available during designated working hours and participate in virtual meetings with cameras on.

🏝️ Benefits

• Fully remote work arrangement.

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

• Comprehensive medical, dental, and vision plans.

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

• Life and disability insurance options.

• Voluntary life insurance options available.

• Access to an Employee Assistance Program (EAP).

• Paid time off plans.

• Paid parental leave.

• Resources for learning and development.

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