The Care Engagement Specialist is responsible for engaging with health plan members to support access to healthcare services, encourage preventive care participation, and promote utilization of available member benefits. This role serves as a key point of contact for members by providing education, scheduling support, and guidance to help improve overall health outcomes and member engagement.

The Care Engagement Specialist works closely with internal teams, providers, and members to identify barriers to care, encourage completion of health screenings, and assist members in understanding and accessing enhanced healthcare benefits and services.

Key Responsibilities:

• Make outbound and receive inbound calls to assist members with scheduling doctor appointments, completing Health Needs Screenings, and addressing benefit eligibility requirements.
• Educate members on available healthcare services, enhanced benefits, and preferred provider options to encourage participation and engagement.
• Support members in understanding appropriate utilization of healthcare services, including education regarding non-emergent Emergency Department usage and its impact on benefits.
• Identify and address barriers preventing members from completing health screenings, accessing services, or securing eligibility for additional benefits.
• Review member profiles prior to outreach efforts to identify opportunities for improved engagement, benefit utilization, and healthcare access.
• Collaborate with internal teams to support member engagement initiatives and ensure positive member experiences.
• Participate in continuous quality improvement initiatives to support departmental and organizational performance goals.
• Review and analyze call activity reports and member interaction data to improve outreach strategies and engagement outcomes.
• Serve as a secondary resource for Member Services and Provider Services call centers as needed.
• Maintain accurate and timely documentation of member interactions and outreach activities.
• Perform additional duties as assigned while maintaining compliance with organizational policies and standards.

Required Qualifications:

• High school diploma or equivalent required
• 5–7 years of experience in sales, customer service, call center operations, or other high-volume engagement environments
• Strong communication, interpersonal, and problem-solving skills
• Ability to effectively engage with members and build rapport in a fast-paced environment
• Experience handling outbound and inbound call activities while meeting performance goals
• Strong organizational skills and ability to manage multiple priorities independently

Preferred Qualifications:

• Experience in healthcare, managed care, Medicaid, or health insurance environments
• Familiarity with member engagement, care coordination, or healthcare outreach initiatives
• Experience educating individuals on healthcare services, benefits, or wellness programs
• Bilingual skills preferred but not required

About the Company:

RepuCare is a certified woman-owned business with over 30 years of experience delivering high-quality healthcare and professional staffing solutions. We are committed to operational excellence and improving outcomes through compassionate, compliant, and client-focused services.

We are currently seeking a Care Engagement Specialist to support our client’s member outreach and engagement operations in a fully remote, work-from-home environment. This position operates Monday through Friday with no weekend hours required.