Medical Contact Center Representative – Inbound/Outbound

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

📋 Description

• Deliver friendly, precise, and prompt service through various inbound and outbound interactions, including phone, email, chat, SMS, video calls, co-browser sessions, and other channels.

• Attentively listen to Customers’ needs and concerns, showcasing empathy while fostering rapport and trust.

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

• Safeguard Customers’ privacy and PHI, ensuring compliance with HIPAA and relevant laws.

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

• Address inquiries concerning benefits, claims, eligibility, provider networks, prior authorizations, preventive health, and other healthcare subjects.

• Investigate, resolve, document, and follow up on intricate Customer issues; escalate recurring concerns and trends as necessary.

• Educate Customers on plan benefits, policies, procedures, self-service portals, and healthcare information.

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

• Execute 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 incoming inquiries from potential enrollees and assist them in the program enrollment process.

• Adhere to scripts, talking points, call flows, dialer workflows, calling regulations, and disclosure standards.

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

• Achieve performance objectives related to CSAT, first contact resolution, quality, efficiency, attendance, and schedule adherence.

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

⛳️ Requirements

• A high school diploma or equivalent is mandatory.

• 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 setting.

• Outstanding customer service skills demonstrated through experience.

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

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

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

• Capability to navigate complex systems and processes efficiently.

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

• Ability to learn and retain information swiftly.

• Capacity to work independently as well as collaboratively within a team, demonstrating high accountability.

• Ability to manage stressful situations with professionalism and composure.

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

• Bilingual skills are considered a plus.

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

• Employees are required to have an internet connection with a minimum of 100 Mbps download and 10 Mbps upload speed.

🏝️ Benefits

• Fully remote work from home options.

• Comprehensive Medical, Dental, and Vision plans.

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

• Life and Disability insurance coverage.

• Options for Voluntary Life insurance.

• Employee Assistance Program (EAP).

• Generous paid time off plans.

• Paid parental leave benefits.

• Access to learning and development resources.

• Necessary equipment provided at no cost to the employee.