Quality Engagement Specialist

Responsibilities

• Conduct inbound/outbound campaigns in accordance with departmental initiatives
• Deliver a superior level of service by providing white‑glove assistance, engaging in positive and empathetic conversations with members
• Provide clear and accurate information regarding health plan coverage, benefits, and claims processes
• Assist members in navigating the healthcare system and understanding their policy
• Educate members on preventive care, wellness programs, and available resources within their health plan
• Collaborate with internal teams to stay updated on policy changes, new benefits, and healthcare regulations
• Ensure members are aware of and understand the various tools and resources available for managing their health
• Gather and analyze customer feedback to identify trends and areas for improvement
• Collaborate with cross-functional teams to implement changes based on customer feedback
• Implement strategies to enhance overall customer satisfaction and loyalty
• Maintain accurate and detailed records of member interactions, ensuring compliance with healthcare privacy regulations

• High school diploma or equivalent required
• Minimum of 2 years of customer service and/or call center experience required
• Experience in healthcare, health insurance, Medicare, managed care, or member services preferred
• Strong verbal and written communication skills
• Strong typing, documentation, and data entry skills
• Ability to explain complex health plan information in a clear and member‑friendly way
• Ability to organize work, manage multiple priorities, and follow campaign‑specific workflows
• Strong attention to detail and commitment to accurate documentation
• Ability to demonstrate empathy, patience, professionalism, and sound judgment in all member interactions
• Familiarity with CRM systems, healthcare software, call center platforms, or Salesforce preferred

Demonstrates expertise in customer service within the healthcare sector, focusing on effective communication, member education, and compliance with healthcare regulations. Proficient in managing member interactions and utilizing CRM systems to enhance customer satisfaction and loyalty.