Medical Contact Center Representative, Inbound/Outbound

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

📋 Description

• Deliver friendly, precise, and prompt assistance to members/patients, providers, and other stakeholders through inbound and outbound communications via phone, email, chat, SMS, video calls, co-browsing sessions, and additional channels.

• Attend to Customers' needs and concerns, showcasing empathy, building rapport, and fostering trust.

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

• Safeguard privacy, dignity, and PHI while adhering to HIPAA and relevant laws and regulations.

• Support various departments including Claims, Utilization Management, Intake, Quality, Care Management, and Patient Engagement.

• 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; escalate recurring issues and trends as needed.

• Educate Customers about plan benefits, policies, procedures, self-service portals, and available resources.

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

• 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 direct them through subsequent steps.

• Clarify program value, features, and benefits; address hesitations and objections using approved scripts and call flows.

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

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

• Attain performance goals for CSAT, first contact resolution, quality, efficiency, attendance, and schedule adherence.

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

⛳️ Requirements

• High school diploma or equivalent is mandatory.

• A minimum of 2 years of customer service experience in 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 environment.

• Exceptional demonstrated customer service skills and a strong desire to assist others.

• Excellent empathy, patience, rapport-building, active listening, problem-solving, and critical-thinking abilities.

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

• Strong persuasion and objection-handling capabilities.

• Comfort in structured outbound calling, scripted call flows, and dialer-based workflows.

• Ability to navigate intricate systems and processes.

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

• Quick learner with the ability to retain information efficiently.

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

• Proficiently manage stressful situations in a professional and calm manner.

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

• Must provide an internet connection with a minimum of 100 Mbps download and 10 Mbps upload, suitable for video calls and system connectivity.

• Bilingual skills are advantageous.

• An Associate's, Bachelor's, or Master’s degree is preferred.

🏝️ Benefits

• Fully remote work arrangement.

• Medical, Dental, and Vision plans.

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

• Life and Disability insurance.

• Voluntary Life options.

• Employee Assistance Program (EAP).

• Paid time off plans.

• Paid parental leave.

• Learning and development resources.

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