Customer Guide Engagement Specialist

About Our Client

The organization is a healthcare company focused on leveraging data, AI, and predictive analytics to improve healthcare affordability and patient outcomes. It integrates remotely embedded health guides with a centralized managed service model to strengthen connections between patients and providers. Led by physicians, the company aims to enhance healthcare quality and value both inside and outside the exam room.

About the Opportunity

The Customer Guide Engagement Specialist serves as a primary contact and trusted guide for members, patients, and providers navigating healthcare benefits and care management. This role is vital for delivering empathetic, clear, and efficient support, helping customers understand and utilize healthcare programs effectively. It contributes directly to the organization’s mission by fostering positive experiences and empowering customers to access appropriate care.

Responsibilities

• Provide timely and accurate service to customers via phone, email, chat, SMS, video calls, and other channels.
• Listen actively to understand customer needs and demonstrate empathy.
• Aid customers in navigating internal processes and resources.
• Build rapport and establish trust to create a personalized experience.
• Protect customers’ privacy and comply with HIPAA and relevant regulations.
• Support other departments such as Claims, Utilization Management, Intake, and Quality as needed.
• Address inquiries on benefits, claims, eligibility, provider networks, and health-related topics.
• Research and resolve complex issues, collaborating with other teams.
• Take ownership of issues, ensuring full resolution and customer satisfaction.
• Identify and escalate recurring issues to management.
• Document interactions and resolutions thoroughly.
• Educate customers on plan benefits, policies, and procedures in clear terms.
• Promote and assist with use of the self-service portal and other resources.
• Conduct outbound outreach for enrollment and clinical quality programs.
• Handle inbound calls from prospective enrollees, qualifying interest, and guiding next steps.

Requirements

• Experience in customer service or healthcare-related roles.
• Strong communication and interpersonal skills.
• Ability to handle complex problem-solving and issue resolution.
• Knowledge of healthcare benefits, claims, and care management processes preferred.
• Commitment to protecting customer privacy and compliance with HIPAA.
• Flexibility to support cross-functional initiatives.

Pay Range and Compensation Package

The pay range and compensation package for this role will be determined based on the candidate’s experience, skills, and other relevant factors.

Equal Opportunity Statement

Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.