Medical Contact Center Representative, Inbound and Outbound

Job Description

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.

WHAT YOU’LL BE DOING

As a growing and innovative organization, we operate with a high degree of agility. Employees are expected to adapt to evolving business needs, step in to support cross-functional initiatives, and contribute beyond traditional role boundaries when needed. This collaborative and flexible mindset is essential to our success. We encourage cross-training, ongoing development, and a commitment to learning across all areas of the business—ensuring we continue to grow as a high-performing, mission-driven team and you continue to grow and thrive as a member of our high-performing, mission-driven team

• 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.

Issue Resolution and Problem Solving:

• 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.

Healthcare Consumer Education:

• 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.

Outbound Outreach and Program Enrollment:

• 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. (Note: Customer Guides do not close sales transactions or collect payments; the focus is enrollment, education, and customer engagement.)

Compliance and Quality:

• 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.

WHAT YOU'LL NEED TO HAVE

• 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. Candidates with experience in both inbound and outbound Customer service via multiple channels are strongly preferred.
• 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.

WOULD LOVE FOR YOU TO HAVE

• 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.

The base pay range for this role is between $20 - $22 per hour paid bi-weekly

ALIVE with Purpose: How We Thrive at Guidehealth

At Guidehealth, our values come to life in everything we do.

• We are Driven by Accountability — grounded in transparency, reliability, and integrity as we navigate challenges and opportunities alike.
• Always Growing, Always Learning — staying curious and continuously improving inspires us to shape a better future for healthcare.
• With Collaborative Innovation, we solve problems creatively, making every experience better for our employees and the patients we serve.
• At Guidehealth, Every Voice Matters — we believe our collective strength is rooted in the unique perspectives of each team member.
• And through Empathy in Action, we build stronger connections with those who count on us.
• This is what it means to be ALIVE with purpose. This is how we thrive — together — at Guidehealth.

BENEFITS:

While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. Temporary employees and contractors are not eligible for benefits.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT

Diversity, inclusion, and belonging are at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.

As a remote-first organization handling sensitive healthcare data, Guidehealth verifies candidate identity at multiple stages of the hiring and onboarding to safeguard patient privacy, data security, and compliance requirements.

REMOTE WORK TECHNICAL REQUIREMENTS

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. 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. Please run a speed test here to confirm your internet connection meets these requirements.

SECONDARY EMPLOYMENT

At Guidehealth, we value transparency and collaboration as part of our commitment to excellence. As your primary employer, we kindly ask all team members to disclose any secondary employment, regardless of whether it may present a potential conflict of interest.

To ensure smooth teamwork and availability, employees must be accessible during our stated working hours. We foster connection and engagement by asking team members to join virtual meetings with their cameras on.