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.

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