Medical Contact Center Representative – Inbound/Outbound

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

📋 Description

• Deliver friendly, precise, and prompt support to members/patients, providers, and other stakeholders via inbound and outbound communication channels including phone, email, chat, SMS, video calls, and co-browsing.

• Attentively listen to customers’ needs, exhibit empathy, cultivate rapport, build trust, and offer tailored assistance.

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

• Safeguard customer privacy and PHI in compliance with HIPAA and relevant laws and regulations.

• Respond to inquiries regarding benefits, claims, eligibility, provider networks, prior authorizations, preventive health, and other healthcare subjects.

• Investigate and resolve intricate issues, document interactions and solutions, and escalate persistent issues or urgent clinical and behavioral health matters.

• Inform customers about plan benefits, policies, procedures, and care-management programs.

• Conduct outbound outreach for enrollment, medication refills, blood pressure checks, preventive care, gap-in-care, and wellness initiatives.

• Address inbound queries from potential enrollees and assist them in navigating care-management program enrollment.

• Adhere to approved scripts, call flows, disclosures, TCPA requirements, state do-not-call regulations, and dialer processes.

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

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

• Engage in training, coaching, professional development, and continuous improvement efforts.

⛳️ Requirements

• High school diploma or equivalent is mandatory.

• At least 2 years of 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.

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

• Proven customer service abilities and a genuine passion for assisting others.

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

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

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

• Ability to navigate complex systems and processes effectively.

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

• Capable of quickly learning and retaining information.

• Ability to work both independently and collaboratively within a team.

• Professional and calm demeanor when managing stressful situations.

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

• Ability to maintain PHI confidentiality and adhere to HIPAA, TCPA, state do-not-call rules, and other regulations.

• Capacity to meet performance objectives regarding CSAT, first-contact resolution, quality, efficiency, attendance, and schedule adherence.

• Personal internet connection with a minimum download speed of 100 Mbps and upload speed of 10 Mbps.

• Bilingual abilities are advantageous.

• Associate’s, bachelor’s, or master’s degree is preferred.

🏝️ Benefits

• Work from home / fully remote position.

• Medical insurance coverage.

• Dental insurance options.

• Vision insurance coverage.

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

• Life and disability insurance benefits.

• Options for voluntary life insurance.

• Employee Assistance Program (EAP) available.

• Paid time off plans provided.

• Paid parental leave offered.

• Access to learning and development resources.

• Necessary work equipment supplied at no cost.

• Flexible remote work arrangements available.

• Full-time employees working 30 hours per week or more qualify for comprehensive benefits.