Medical Contact Center Representative – Inbound/Outbound

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

📋 Description

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

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

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

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

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

• Inform Customers about plan benefits, policies, procedures, self-service portals, and healthcare information.

• 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 calls from potential enrollees, assess interest, explain program value, and guide next steps.

• Utilize approved scripts, talking points, call flows, and dialer-based workflows; oversee call dispositions and achieve productivity and quality targets.

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

• Adhere to TCPA, state do-not-call regulations, HIPAA, and company policies.

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

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

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

⛳️ 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 environment, or in roles such as program enrollment, telemarketing, cold calling, appointment setting, inside sales, or other outbound calling positions.

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

• Excellent customer service skills with a genuine passion for helping others.

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

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

• Capability to communicate clearly, concisely, and professionally.

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

• Proficiency in navigating complex systems and processes.

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

• Quick learner with the ability to retain information effectively.

• Capacity to work independently as well as collaboratively with a strong sense of accountability.

• Ability to manage stressful situations with professionalism and composure.

• Knowledge of medical terminology, healthcare benefits, and insurance processes.

• Commitment to protecting PHI and adhering to HIPAA and relevant laws and regulations.

• Proficient in utilizing multiple communication channels.

• Bilingual abilities are advantageous.

• Preferred qualifications include an Associate's, Bachelor's, or Master's degree.

🏝️ Benefits

• Fully remote work arrangement.

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

• Comprehensive Medical, Dental, and Vision insurance plans.

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

• Life and Disability insurance options.

• Voluntary Life insurance available.

• Employee Assistance Program (EAP).

• Paid time off plans.

• Paid parental leave.

• Access to learning and development resources.

• Bi-weekly pay schedule.

• Flexible work arrangement helping to reduce commute time.