Customer Guide Engagement Specialist

Customer Guide Engagement Specialist

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 Engagement Specialist 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.

As a growing and innovative organization, we operate with a high degree of agility. Employees are expected to adapt to evolving business needs, step in to support cross-functional initiatives, and contribute beyond traditional role boundaries when needed. This collaborative and flexible mindset is essential to our success. We encourage cross-training, ongoing development, and a commitment to learning across all areas of the business—ensuring we continue to grow as a high-performing, mission-driven team and you continue to grow and thrive as a member of our high-performing, mission-driven team.

• 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…