Customer Guide Engagement Specialist

About the role

In the position of Customer Guide Engagement Specialist at Guide Health, you will play a crucial role as the primary liaison between our organization and our valued customers, which include members, patients, and healthcare providers. Your responsibilities will extend beyond typical customer service tasks; you will act as a knowledgeable navigator, assisting customers through the complexities of healthcare benefits and care management. This role involves handling inbound service inquiries, managing outbound outreach efforts, and ensuring that every interaction is characterized by empathy, efficiency, and a commitment to exceptional service.

Key facts

What you'll do

• Deliver friendly, accurate, and timely assistance to customers through various communication channels, including phone, email, chat, SMS, and video calls.
• Actively listen to customers to fully understand their needs and concerns, demonstrating empathy and patience throughout the interaction.
• Guide customers through internal processes and available resources to help them achieve their desired outcomes.
• Establish rapport and trust with customers, ensuring a personalized and positive experience.
• Exceed customer expectations by going the extra mile to leave a lasting impression.
• Safeguard customers' privacy and personal health information (PHI) while adhering to HIPAA regulations and other legal requirements.
• Provide backup support to other departments, such as Claims, Utilization Management, and Care Management, while performing additional duties as assigned.
• Address inquiries related to benefits, claims, eligibility, provider networks, and other healthcare topics, ensuring accurate and timely responses.
• Collaborate with other departments to resolve complex issues and take ownership of customer problems until they are fully resolved.
• Identify and escalate recurring issues or trends to management proactively.
• Document all customer interactions and resolutions meticulously in the appropriate systems.
• Educate customers about plan benefits, policies, and procedures, ensuring they understand complex healthcare information clearly.
• Encourage the use of self-service portals and guide customers on how to navigate these resources effectively.
• Conduct outbound enrollment outreach to invite eligible members to participate in care management programs.
• Perform outbound clinical quality outreach, including wellness check-ins and preventive care reminders.
• Handle inbound calls from prospective enrollees, guiding them through the enrollment process and addressing their inquiries.
• Communicate the value and benefits of our programs in a customer-centered manner, helping customers make informed health decisions.
• Follow approved scripts and adapt your tone and pacing to suit individual customer interactions.
• Manage outbound workflows effectively while ensuring compliance with all relevant regulations and policies.

Requirements

• A high school diploma or equivalent is mandatory.
• At least 2 years of experience in customer service within a health plan, HMO, TPA, or healthcare setting, or in roles such as program enrollment, telemarketing, or inside sales.
• A minimum of 1 year of experience in a healthcare contact center or outbound calling environment is required.
• Proven customer service skills with a genuine passion for assisting others.
• Strong empathy and the ability to connect with a diverse range of individuals.
• Excellent verbal and written communication skills, including proper grammar and pronunciation in English.
• Ability to communicate professionally and clearly, addressing customer needs effectively.
• Strong persuasion skills and the ability to handle objections while articulating the value of services.
• Comfort with structured outbound calling and scripted workflows.
• Resilience and a positive attitude when dealing with refusals or high call volumes.
• Strong problem-solving abilities and critical thinking skills.

Nice to have

• Experience with healthcare management systems or CRM tools.
• Familiarity with HIPAA regulations and compliance standards.
• Bilingual abilities, particularly in Spanish, to better serve a diverse customer base.
• Previous experience in a fast-paced, high-volume customer service environment.
• Knowledge of healthcare benefits and care management principles.

Skills & tools

• Proficient in using communication tools such as phone systems, email platforms, and chat applications.
• Familiarity with customer relationship management (CRM) software and data entry systems.
• Strong organizational skills and the ability to manage multiple tasks efficiently.

Practical notes

• This position is based in Dallas, US, and is a full-time role.
• The salary for this position will be competitive and commensurate with experience.
• Candidates must be eligible to work in the US and may require visa sponsorship depending on their circumstances.

Join Guide Health and be part of a team that values innovation, teamwork, and a commitment to exceptional service. Your role as a Customer Guide Engagement Specialist will not only enhance the lives of our customers but also contribute to a positive and supportive workplace culture where everyone can thrive.