Customer Guide Engagement Specialist

About Guidehealth

Guidehealth is a healthcare organization that uses data, AI, and predictive analytics to improve care quality, support clinical outcomes, and make healthcare more affordable. The company combines remotely embedded Healthguides™ with a centralized Managed Service Organization to strengthen the relationship between patients, providers, and care teams. Its approach is physician-led, outcome-focused, and designed to support better experiences both inside and outside the exam room.

Guidehealth operates in a fast-moving environment where employees are expected to stay flexible, adapt to changing priorities, and contribute across team boundaries when needed. Ongoing learning, cross-training, and collaboration are part of the culture.

Role Overview

As a Customer Guide Engagement Specialist, you will represent Guidehealth as a key contact for members/patients, providers, and other stakeholders. This is not just a standard customer service role; it involves helping people understand healthcare benefits, guiding them through care-related processes, and supporting outreach for enrollment and wellness engagement. The position includes both inbound and outbound work across multiple communication channels, with a strong emphasis on empathy, clarity, and timely resolution.

What You Will Do

• Support customers through phone, email, chat, SMS, video, co-browsing, and other communication methods, handling both incoming and outgoing interactions.
• Listen carefully to understand concerns, respond with empathy, and create a reassuring customer experience.
• Help customers find the right resources and navigate internal processes to reach a resolution.
• Build trust and rapport while delivering personalized, human-centered support.
• Represent the company in a way that leaves a positive and lasting impression.
• Safeguard customer privacy, dignity, and Personal Health Information, while following HIPAA and all relevant laws and regulations.
• Assist other teams such as Claims, Utilization Management, Intake, Quality, Care Management, and Patient Engagement when needed.
• Answer questions about benefits, claims, eligibility, provider networks, prior authorizations, preventive health, and related healthcare topics.
• Investigate and resolve complex cases by working with internal departments as required.
• Take ownership of issues through to completion and ensure the customer receives a satisfactory resolution.
• Identify recurring problems or trends and escalate them to management when appropriate.
• Record all customer interactions and outcomes accurately in the proper systems.
• Explain health plan benefits, policies, and procedures in simple, easy-to-understand language.
• Encourage use of the self-service portal and teach customers how to access and use available tools.
• Conduct outbound outreach for care management and care coordination program enrollment.
• Complete clinical quality and wellness outreach such as medication refill reminders, blood pressure check-ins, preventive care reminders, gap closure, and general wellness calls.
• Handle inbound interest from prospective enrollees and guide them through the next steps.
• Communicate program value clearly while using consultative listening and respectful objection handling.
• Work from approved scripts, talking points, and call flows while adjusting tone and pacing to each member.
• Operate within dialer-based workflows, track call outcomes correctly, and meet productivity and quality expectations.
• Recognize clinical or behavioral health concerns and escalate urgent needs appropriately.
• Follow all outbound calling requirements, including TCPA, state do-not-call rules, and disclosure standards.
• Note that the role does not include closing sales transactions or collecting payments; the focus is on enrollment, education, and engagement.
• Accept coaching, feedback, and development opportunities from coaches, trainers, peers, and managers.
• Meet goals for customer satisfaction, first contact resolution, quality, efficiency, attendance, and schedule adherence.
• Continue learning through ongoing training and contribute ideas that improve team performance and the customer experience.

Qualifications

• A high school diploma or equivalent is required.
• At least 2 years of experience in one or more of the following areas: customer service within a health plan, HMO, TPA, or healthcare setting; program enrollment; telemarketing; cold calling; appointment setting; inside sales; or another outbound calling role.
• At least 1 year of experience working in a healthcare contact center or outbound calling environment.
• Strong customer service instincts and a genuine interest in helping others.
• High levels of empathy, patience, and relationship-building ability.
• Excellent spoken and written English, including grammar and pronunciation.
• Clear, professional communication style with strong active listening skills.
• Persuasion and objection-handling ability suited to enrollment and engagement conversations.
• Comfort using scripted call flows, structured outreach, and dialer tools.
• Ability to stay professional and resilient when facing refusals, voicemail, and repetitive outreach work.
• Solid problem-solving, critical-thinking, and process-navigation skills.
• Comfort using computer systems, CRM tools, and Microsoft Office applications.
• Fast learning ability, strong accountability, and the capacity to work both independently and collaboratively.
• Professional composure under pressure and familiarity with medical terminology, healthcare benefits, and insurance processes.
• Bilingual ability is an advantage.
• An associate’s, bachelor’s, or master’s degree is preferred.

Pay and Compensation

The base pay for this position is $20 to $22 per hour, paid bi-weekly. Final pay is influenced by factors such as skills, relevant experience, education, location, and any applicable licensure or certifications.

Benefits

• Fully remote work arrangement.
• Medical, dental, and vision coverage.
• 401(k) plan with a 3% employer match on a 6% employee contribution.
• Life and disability insurance, plus voluntary life coverage options.
• Employee Assistance Program for additional support.
• Paid time off to support work-life balance.
• Paid parental leave.
• Learning and development resources to support career growth.

Eligibility and Benefits Notes

Full-time employees working 30 hours per week or more are eligible for the company’s full benefits package. Temporary employees and contractors are not eligible for benefits.

Company Values

• Accountability through transparency, reliability, and integrity.
• Continuous learning and improvement.
• Creative, collaborative innovation.
• Respect for every voice and perspective.
• Empathy in action across all interactions.