Medical Contact Center Representative, Inbound/Outbound

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

📋 Description

• Deliver friendly, precise, and prompt service to members/patients, providers, and stakeholders via inbound and outbound phone calls, emails, chats, SMS, video calls, and co-browsing sessions.

• Actively listen, show empathy and patience, build rapport, and establish trust with customers.

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

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

• Investigate, resolve, document, and follow up on complex customer issues, while escalating recurring trends or urgent matters as necessary.

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

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

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

• Manage inbound inquiries from potential enrollees, assess interest, clarify program value, and guide next steps.

• Adhere to approved scripts, talking points, call flows, outbound calling regulations, and disclosure standards.

• Utilize dialer-based workflows, manage call dispositions, and achieve outreach productivity and quality objectives.

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

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

• Achieve performance goals for customer satisfaction (CSAT), first contact resolution, quality, efficiency, attendance, and schedule adherence.

• Engage in coaching, training, 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 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 setting.

• Outstanding customer service skills and a strong commitment to helping others.

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

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

• Strong skills in persuasion and handling objections.

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

• Demonstrated resilience and professional composure when dealing with refusals, voicemails, unanswered calls, and repetitive dialing.

• Ability to navigate complex systems and processes proficiently.

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

• Quick learner with the ability to retain information effectively.

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

• Ability to maintain professionalism in stressful situations.

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

• Requirement for a minimum internet connection of 100 Mbps download and 10 Mbps upload.

• Bilingual skills are advantageous.

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

🏝️ Benefits

• Fully remote work / work from home.

• Medical, dental, and vision insurance plans.

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

• Life and disability insurance coverage.

• Options for voluntary life insurance.

• Employee Assistance Program (EAP).

• Paid time off plans.

• Paid parental leave.

• Resources for learning and development.

• Necessary work equipment provided at no cost.

• Virtual meetings with cameras on.

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