About the Opportunity
Our client is a well-established healthcare organization providing health insurance and related services to members throughout Southern New England. They are seeking a Member & Provider Outreach Representative to support both prospective members and participating healthcare providers through inbound and outbound phone and email communication.
This position is ideal for a customer-focused professional who is comfortable working in a high-volume environment, maintaining accurate records, and communicating effectively with both members and healthcare practices.
Position Summary
The Member & Provider Outreach Representative will provide timely, professional support to prospective members and healthcare providers. The role combines customer service, outbound outreach, data entry, CRM activity, and provider access verification.
The successful candidate will be highly organized, detail-oriented, comfortable on the phone, and able to manage multiple priorities while maintaining a high level of accuracy and professionalism.
Key Responsibilities
Respond to inbound phone and email inquiries from prospective members and provide assistance throughout the enrollment process.
Conduct outbound outreach to prospective members and participating healthcare providers.
Coordinate follow-up conversations between prospective members and internal enrollment or sales representatives.
Enter and maintain accurate customer and outreach information within the CRM system.
Document outreach activities, responses, outcomes, and follow-up requirements in designated systems.
Maintain accurate records to support provider network management, operational reporting, and compliance requirements.
Prepare reports and summaries regarding outreach activity, trends, and identified issues.
Contact primary care practices to verify appointment availability for new and existing patients.
Collect and document information such as appointment availability, estimated wait times, practice location, and other relevant access details.
Identify and escalate provider access issues or other concerns to the appropriate internal team.
Deliver a consistently professional, courteous, and service-oriented experience to members, providers, and internal stakeholders.
Perform additional responsibilities and special projects as assigned.
Skills & Qualifications
Strong verbal and written communication skills.
Excellent customer service and interpersonal skills.
Comfortable making and receiving a high volume of telephone calls.
Ability to handle inquiries professionally, determine appropriate next steps, and escalate issues when necessary.
Strong attention to detail and accuracy in data entry and documentation.
Ability to organize and prioritize multiple tasks with minimal supervision.
Proficiency with Microsoft Office Suite.
Experience with Salesforce or another CRM platform preferred.
Previous experience in healthcare, health insurance, provider networks, primary care, or a related environment is a plus.
Ability to work effectively in a team-oriented, fast-paced environment.
What We're Looking For
The ideal candidate is a dependable and service-minded professional who enjoys interacting with people and is comfortable balancing high-volume communication, administrative responsibilities, and detailed data management. Strong follow-through, professionalism, and attention to detail are essential for success in this role.
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