Call Center Support Specialist

Job Summary

The Call Center Support Specialist supports the Member Access Center (MAC) by providing high-quality inbound and outbound call handling and virtual administrative execution. This role serves as an administrative and scheduling partner to clinical, care coordination, and operations teams by managing high-volume interactions, coordinating multi-step workflows, and ensuring accurate documentation across systems.

Core responsibilities

• Answer incoming calls promptly and professionally within defined service level expectations; provide accurate information and ensure a positive member experience.
• Conduct outbound phone calls to members within defined timeframes for reminders, confirmations, rescheduling, outreach, and administrative follow-up.
• Respond to routine inquiries with empathy, professionalism, and cultural sensitivity; route or redirect questions as appropriate per standardized workflows.
• Collect, verify, and document information accurately in the Electronic Health Record (EHR/EMR) and other systems during member interactions.
• Follow communication scripts and call flows based on market, location, and call type; ensure accurate messaging and consistent member experience.
• Provide excellent customer service when greeting and engaging members, providers, and external partners; support first-call resolution when possible.
• Manage shared inboxes, queues, and worklists to ensure timely responses, accurate processing, and task completion.
• Schedule and reschedule appointments in accordance with policy and procedure, considering member preference, insurance coverage, visit type, and market workflow requirements.
• Provide appointment reminders and confirmation calls; support rescheduling and conversion to virtual visits when appropriate, following established protocols to help reduce no-show rates.
• Route, screen, and escalate concerns appropriately based on established protocols and clinical guidance; document and notify the Call Center Supervisor as needed for service recovery, repeat issues, or member safety concerns.
• Accurately document all outreach, scheduling activity, and member interactions in the EHR/EMR; confirm work for completeness and accuracy.
• Complete and document required forms, paperwork, and assessments while speaking with members, as assigned.
• De-escalate situations involving dissatisfied members; provide assistance and support while maintaining professionalism and composure.
• Maintain professionalism and composure while supporting individuals with complex medical, behavioral, and social needs.
• Demonstrate a working knowledge of insurance coverage and benefits, appropriate screening of member needs, and general procedures of a physician office.
• Aid members with general inquiries related to scheduling, transportation, pharmacy, and care navigation; coordinate across internal teams when issues require multiple steps.
• Proficient use of the EHR/EMR, phone system, and Microsoft products; ability to toggle between multiple applications regularly.
• Schedule transportation for members as needed, following local market parameters and documenting outcomes appropriately.
• Complete administrative tasks such as faxing, sorting, scanning, and categorizing documents as appropriate; support timely processing and accurate recordkeeping.
• Meet personal and team-based performance expectations, key performance indicators (KPIs), and metrics (e.g., productivity, quality, adherence, and engagement).
• Participate in regular team meetings, training sessions, and quality improvement efforts; implement updates to scripts, workflows, and job aids as released.
• Maintain confidentiality and adhere to HIPAA and organizational compliance standards.
• Other duties are assigned to support MAC priorities, access initiatives, and administrative workflow needs.

Minimum Qualifications

• High School Diploma or equivalent
• 1+ years of healthcare experience, community outreach, or a similar role
• 1+ years of experience working in a call center or healthcare provider front office
• Strong organizational and time management skills
• Comfortable working with performance metrics, quality expectations, and outreach targets
• Empathy and cultural competence when working with diverse populations
• Proficient with basic computer systems, including electronic health records

Preferred

• Basic understanding/knowledge of medical terminology
• Experience in sales or conducting outreach and retention calls
• Familiarity with Medicaid and Medicare populations
• Familiarity with electronic health records
• Bilingual (English/Spanish) is a plus