Leading a movement where creativity delivers positive change. Learn more guidehealthcare.com.au
Customer Engagement Specialist
Location
United States
Posted
7 days ago
Salary
$20 - $22 / hour
Seniority
Mid Level
Job Description
Customer Engagement Specialist
Guide Healthcare
• 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. • 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. • 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).
Job 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.
- 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.
Benefits
- 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: 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.
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