Medical Contact Center Representative, Inbound/Outbound

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

📋 Description

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

• Demonstrate empathy, foster rapport, build trust, and curate customized customer experiences.

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

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

• Investigate complex issues, collaborate with Claims, Provider Relations, Utilization Management, Intake, Care Management, Quality, and other departments, and escalate recurring or urgent matters as needed.

• Accurately document customer interactions and resolutions in the appropriate systems.

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

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

• 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 program inquiries, qualify interest, articulate program value, and guide potential enrollees through subsequent steps.

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

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

• Safeguard PHI and customer privacy while adhering to HIPAA and relevant laws.

• Meet benchmarks for customer satisfaction, first-contact resolution, quality, efficiency, attendance, and schedule adherence.

• Engage in training, coaching, professional development, cross-training, and process enhancement initiatives.

• Provide support to other departments and fulfill additional assigned responsibilities.

⛳️ Requirements

• High school diploma or equivalent is required.

• At least 2 years of experience in customer service within a health plan, HMO, TPA, or healthcare environment; or experience in program enrollment, telemarketing, cold calling, appointment setting, inside sales, or similar outbound calling roles.

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

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

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

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

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

• Ability to navigate complex systems and processes effectively.

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

• Capacity to learn and retain information quickly.

• Ability to work both independently and collaboratively as part of a team with a strong sense of accountability.

• Capability to handle stressful situations professionally and with composure.

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

• Ability to protect PHI and comply with HIPAA, TCPA, state do-not-call regulations, and applicable laws.

• Bilingual skills are an advantage.

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

🏝️ Benefits

• Work from home / fully remote work.

• Necessary equipment provided at no cost to the employee.

• Comprehensive medical, dental, and vision plans.

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

• Life and disability insurance.

• Options for voluntary life insurance.

• Employee Assistance Program (EAP).

• Paid time off plans.

• Paid parental leave.

• Learning and development resources.

• Virtual meetings with cameras on.

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