Medical Contact Center Representative, Inbound and Outbound

Guidehealth; San Antonio (TX); On-site; USD 38,000 - 55,000; Full time

Job summary

Guidehealth in Texas is seeking a Medical Contact Center Representative to handle inbound and outbound member and provider interactions. You will deliver empathetic service, guide patients through benefits and care programs, and act as a trusted navigator in complex healthcare processes.

This full-time role emphasizes privacy, HIPAA compliance, cross-functional collaboration, and proactive issue resolution, with opportunities to grow as you support Claims, UM, Intake, and Care Management teams.

Qualifications

• Actively listen to understand Customers’ needs and concerns.
• Navigate healthcare benefits and care management processes.
• Build rapport and deliver empathetic, patient-centered service.
• Protect PHI and comply with HIPAA and relevant laws.

Responsibilities

• Handle inbound and outbound calls with members and providers.
• Answer inquiries about benefits, claims, eligibility, and networks.
• Collaborate with Claims, UM, Intake, Quality, and Care Management as needed.
• Identify recurring issues and escalate to leadership for resolution.

Job description

Medical Contact Center Representative, Inbound and Outbound

• Full-time

WHO IS GUIDEHEALTH?

Guidehealthis a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealthleverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealthempowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients.

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 and you continue to thrive as a high-performing, mission-driven team.

Join us as we put healthcare on a better path!!

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

• 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 elevate recurring issues or trends to management.