Medical Contact Center Representative, Inbound and Outbound

Guidehealth•San Antonio, TX

12h•$41,600 - $45,760•Remote

About The Position

At Guidehealth, we are committed to creating a positive and supportive work environment where our employees can THRIVE. We value teamwork, innovation, technical aptitude, and a dedication to providing exceptional service to our Customers. Join our team and make a difference in the lives of others! As a Customer Guide Engagement Specialist at Guidehealth, you serve as the voice of our company and a primary point of contact for our valued members/patients and providers (“Customers”). You are more than a responsive Customer service representative; you are a trusted navigator, a problem-solver, and an expert guide through the often complex world of healthcare benefits and care management. Your work spans inbound service calls, inbound program inquiries, and outbound outreach — including enrollment invitations and clinical quality calls such as medication refill reminders, blood pressure checks, and wellness check-ins. Your main focus is to deliver an exceptional, empathetic, efficient experience in every interaction. You’ll build trust, resolve issues, and empower members/patients to take full advantage of the benefits and care programs available to them through expert guidance and clear, human-centered communication.

Requirements

High school diploma or equivalent required.
Minimum of 2 years of experience in one or more of the following: customer service in a health plan, HMO, TPA, or healthcare setting; OR 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 environment.
Exceptional, demonstrated customer service skills, with a genuine passion for helping others.
Strong empathy, patience, and the ability to build rapport with diverse individuals.
Excellent verbal and written communication skills, excellent grammar, and pronunciation in the English language.
Ability to communicate clearly, concisely, and professionally.
Active listening skills and the ability to understand and address customer needs effectively.
Strong persuasion and objection-handling skills, with the ability to articulate the value of programs and services in a clear, Customer-centered way (note: this role does not involve closing sales transactions or collecting payment).
Comfort with structured outbound calling, scripted call flows, and dialer-based workflows.
Resilience and a positive, professional attitude when navigating refusals, voicemails, unanswered calls, and repetitive dialing volume.
Strong problem-solving and critical-thinking abilities.
Ability to navigate complex systems and processes.
Proficiency with computer systems, including CRM software and Microsoft Office Suite.
Ability to learn and retain information quickly.
Ability to work independently and as part of a team; must possess a high level of accountability for your work and in support of the team and the business.
Ability to handle stressful situations with professionalism and composure.
Knowledge of medical terminology, healthcare benefits, and insurance processes.
Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 100 mbps download, 10 mbps upload.

Nice To Haves

Candidates with experience in both inbound and outbound Customer service via multiple channels are strongly preferred.
Bilingual skills are a plus.
Associate's, bachelor's or master’s degree preferred.

Responsibilities

Provide friendly, accurate, and timely service to Customers (members/patients, providers, and other stakeholders) through inbound and outbound interactions via phone, email, chat, SMS, video calls, co-browser sessions, and other communication channels.
Actively listen to understand Customers’ needs and concerns and demonstrate empathy and patience.
Help Customers navigate internal processes and available resources to achieve their desired results.
Build rapport and establish trust with Customers to create a positive, personalized experience.
Go above and beyond to exceed Customer expectations and leave a lasting positive impression.
Protect Customers’ privacy, dignity, and Personal Health Information (PHI) at all times and comply with HIPAA and all applicable laws and regulations.
Backup and support other departments (i.e., Claims, UM, Intake, Quality, Care Management, Patient Engagement) and perform a variety of other duties as assigned.
Answer inquiries regarding benefits, claims, eligibility, provider networks, prior authorizations, preventative health promotion, and other healthcare-related topics.
Research and resolve complex issues, collaborating with other departments as needed (e.g., Claims, Provider Relations, Utilization Management, Intake, Care Management, Quality, etc.).
Take ownership of Customer issues, following through to ensure complete resolution and satisfaction.
Proactively identify and escalate recurring issues or trends to management.
Document all interactions and resolutions accurately and thoroughly in the appropriate systems.
Research and solve Customer issues and reply to Customer inquiries with friendly, accurate, and timely resolutions.
Educate Customers on plan benefits, policies, and procedures.
Clearly and concisely explain complex healthcare information in a way that is easy to understand.
Encourage the use of our self-service portal and effectively teach Customers how to navigate and use our portal and other available resources.
Empower Customers with the knowledge they need to make informed decisions about their health and benefits.
Conduct outbound enrollment outreach, inviting eligible members/patients to join Guidehealth’s care management and care coordination programs.
Conduct outbound clinical quality and wellness outreach, including medication refill reminders, blood pressure check-ins, preventive care reminders, gap-in-care closure, and general wellness check-ins.
Handle inbound calls from prospective enrollees inquiring about Guidehealth’s care management programs, qualifying interest and guiding them through next steps.
Clearly articulate the value, features, and benefits of our programs in plain, customer-centered language, helping Customers understand how participation supports their health goals.
Apply consultative listening and persuasion skills to address hesitation, answer questions, and overcome common objections with empathy, patience, and respect for the Customer’s decision.
Follow approved scripts, talking points, and call flows while adapting tone and pacing to each individual member.
Operate effectively within dialer-based outbound workflows, manage call dispositions accurately, and meet outreach productivity and quality targets.
Recognize and appropriately escalate clinical and behavioral health concerns, as well as urgent member needs, identified during Customer interactions.
Comply with all applicable outbound calling regulations and policies, including TCPA, state do-not-call rules, and Guidehealth scripting and disclosure standards.
Actively seek and accept coaching, feedback, and opportunities for professional development from peers, Customer Guide Coaches, Trainers, and Managers.
Adhere to all company policies, procedures, and regulatory requirements (e.g., HIPAA).
Maintain confidentiality and protect sensitive member information.
Meet or exceed individual and team performance goals related to Customer satisfaction (CSAT), first contact resolution, quality, efficiency, attendance, and schedule adherence.
Participate in ongoing training and development to enhance skills and knowledge.
Contribute thoughtful ideas and suggestions for improvement and promote a positive and collaborative team environment.