Summary

The Healthcare Call Center Agent is responsible for providing exceptional customer service to members, providers, and other stakeholders by handling inbound and outbound calls, responding to electronic mail, and other methods of secure correspondence. This role involves researching claims, verifying insurance, resolving inquiries, and ensuring compliance with healthcare regulations. The ideal candidate is empathetic, detail-oriented, and committed to delivering a positive contact experience.

Your role in our mission

• Answer incoming calls promptly and professionally, addressing member or provider inquiries, and make outbound calls as needed. Ability to remain calm and professional in high pressure situations.
• Accurately document all interactions in the system, ensuring records are updated and complete.
• Maintain confidentiality and comply with HIPAA and other healthcare regulations.
• Escalate complex issues to supervisors or appropriate departments when necessary.
• Meet or exceed performance metrics including adhering to standardized call scripting and quality guidelines, call handle time, customer satisfaction and adhere to a daily work, lunch and break schedule.

What we're looking for

• High school diploma or equivalent required; associate degree or healthcare certification preferred.
• 1+ year of experience in a call center or customer service role, preferably in a healthcare setting. Knowledge of Medicaid/Medicare programs, state healthcare guidelines, or willingness to quickly learn complex program policies.
• Strong communication with ability to show empathy and active listening skills to understand member and provider concerns and respond with compassion and clarity. Demonstrate high attention to detail for compliance-driven processes, along with conflict resolution skills when speaking to frustrated providers or members. Must be able to speak, read and write proficient English. Bilingual is a plus.
• Ability to multitask and navigate multiple systems simultaneously and proficiency in Microsoft office and call center software.
• Familiarity with medical terminology and insurance processes is a plus.

What you should expect in this role

• Candidates must be available to work a designated 8.5 hour shift Monday - Friday between 7am to 6pm Eastern.
• Ability to remain in a stationary position (sitting or standing) for extended periods of time while using a computer and telephone headset. Ability to operate standard office equipment, including computer, keyboard, mouse, and telephone.
• Regular attendance and punctuality are essential to meet adherence and service level requirements.
• A fast-paced, metrics driven environment
• To work effectively as a teleworker or hybrid positions with Gainwell, employees must have a broadband internet connection with a minimum speed of 24 Mbps download and 8 Mbps upload. Higher speeds are recommended for optimal performance.
• To test your internet speed, go to Google and search for “Internet Speed Test.”
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• The deadline to submit applications for this posting is 08/01/2026. LS