Customer Guide

Responsibilities

• 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.
• Empower Customers with the knowledge they need to make informed decisions about their health and benefits.
• Outbound Outreach and Program Enrollment:
• Conduct outbound enrollment outreach, inviting eligible members/patients to join Guidehealth's care management and care coordination programs.
• Conduct outbound clinical quality and wellness outreach, including medication refill reminders, blood pressure check-ins, preventive care reminders, gap-in-care closure, and general wellness check-ins.
• Handle inbound calls from prospective enrollees inquiring about Guidehealth's care management programs, qualifying interest and guiding them through next steps.
• Clearly articulate the value, features, and benefits of our programs in plain, customer-centered language, helping Customers understand how participation supports their health goals.
• Apply consultative listening and persuasion skills to address hesitation, answer questions, and overcome common objections with empathy, patience, and respect for the Customer's decision.
• Follow approved scripts, talking points, and call flows whil

Benefits

Additional Information

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 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.

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