Medical Contact Center Representative, Inbound/Outbound

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

📋 Description

• Deliver courteous, precise, and prompt assistance to members/patients, providers, and other stakeholders via inbound and outbound communications including phone, email, chat, SMS, video calls, co-browser sessions, and various other channels.

• Engage in active listening, exhibit empathy and patience, foster rapport, and build trust with Customers.

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

• Safeguard Customer privacy, dignity, and PHI in compliance with HIPAA and relevant regulations.

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

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

• Investigate intricate issues, collaborate with other departments, document interactions, and escalate recurring problems or trends.

• Educate Customers regarding plan benefits, policies, procedures, self-service portals, and accessible resources.

• Initiate outbound enrollment, clinical quality, medication refill, blood pressure, preventive care, gap-in-care, and wellness outreach.

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

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

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

• Achieve Customer satisfaction, first-contact resolution, quality, efficiency, attendance, and schedule adherence objectives.

• Engage in coaching, training, professional growth, and process enhancement.

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

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

• Outstanding customer service skills and a genuine passion for assisting others.

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

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

• Strong persuasion and objection-handling capabilities.

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

• Ability to navigate complex systems and procedures.

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

• Capability to learn and retain information swiftly.

• Ability to work independently and collaboratively within a team with high accountability.

• Capacity to handle stressful situations professionally and calmly.

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

• Bilingual skills are an advantage.

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

• Employees must provide internet service capable of video calls and access to internal/external systems, with a minimum of 100 Mbps download and 10 Mbps upload speeds.

• Employees must be available during designated working hours and participate in virtual meetings with cameras on.

🏝️ Benefits

• Fully remote work opportunity.

• Medical, Dental, and Vision insurance plans.

• 401(k) plan with a 3% employer match on the employee's 6% contribution.

• Life and Disability insurance coverage.

• Optional Voluntary Life insurance plans.

• Access to an Employee Assistance Program (EAP).

• Paid time off benefits.

• Paid parental leave available.

• Resources for learning and development.

• Required work equipment provided at no cost.

• Commitment to equal opportunity employment.