Job Title
Quality Outreach Specialist (US Healthcare – Medicare Advantage)
Location
India / Philippines (Onsite and/or Remote)
Reporting To
Quality Lead / Population Health Manager
Role Overview
The Quality Outreach Specialist is responsible for driving improvement in Medicare Advantage Star Ratings, HEDIS measures, and Population Health Management (PHM) outcomes through targeted member outreach and engagement.
This role focuses on care gap closure execution, primarily through outbound calling and progressively through multi-channel outreach (texts/emails). The specialist engages members to improve compliance with preventive care, screenings, and chronic condition management while ensuring a high-quality member experience.
The role requires strong healthcare knowledge, effective communication skills, and a results-driven approach to outreach and member satisfaction. It also involves coordination with internal care management and quality teams to ensure seamless care delivery and gap closure.
Key Responsibilities
1. Stars / HEDIS / Population Health Gap Closure Execution
- Conduct outreach to members with open care gaps using available data and reports
- Execute outreach strategies to close gaps, including:
- Outbound calls (primary channel)
- Text messaging campaigns (as applicable)
- Email outreach (as applicable)
- Educate members on:
- Preventive care and screenings
- Chronic condition management
- Support appointment scheduling and follow-up coordination to ensure gap closure
2. Member Engagement & Care Coordination
- Build rapport with members to drive engagement and care compliance
- Provide clear, non-clinical education aligned with measure requirements
- Guide members in navigating healthcare services and completing recommended care
- Partner with care management and quality teams for high-risk or complex cases
3. Outreach Quality & Experience
- Deliver high-quality, empathetic, and compliant member interactions
- Follow defined scripts, workflows, and regulatory guidelines (HIPAA compliant)
- Maintain strong focus on member satisfaction and experience outcomes
- Handle sensitive health-related conversations with professionalism
4. Documentation & Data Accuracy
- Accurately document outreach outcomes in designated systems
- Update care gap status and member interaction details
- Ensure data integrity and audit readiness
- Track outreach activities and follow-ups
5. Performance & Productivity
- Meet defined targets for:
- Call volume and productivity
- Care gap closure rates
- Member engagement and satisfaction metrics
- Continuously improve outreach effectiveness based on feedback and performance data
Required Experience & Qualifications
Must-Have
- 2–5+ years of experience in US Healthcare / Healthcare BPO / Population Health / Care Coordination
- Experience in member outreach, calling, or engagement roles
- Strong understanding of healthcare concepts and care gaps
- Excellent verbal communication and call handling skills
- Ability to build rapport and influence member behavior
- Experience working with healthcare systems, CRM tools, or dialers
Good to Have
- Exposure to Medicare Advantage, HEDIS, or Stars programs
- Experience in preventive care or chronic disease outreach
- Familiarity with care management workflows or PHM programs
- Background in healthcare operations or payer/provider environments
Key Competencies
- Member engagement and influencing skills
- Strong communication and empathy
- Results orientation and accountability
- Attention to detail and process adherence
- Basic understanding of healthcare quality programs
- Time management and productivity focus
Work Expectations
- Ability to work in a high-volume calling environment
- Comfortable balancing member interaction with documentation requirements
- Adherence to HIPAA and healthcare compliance standards
- Flexibility during campaign peaks and quality initiatives
- Willingness to adapt to new outreach channels and workflows
Key Performance Indicators (KPIs)
- Care gap closure rate
- Call productivity and contact rate
- Member engagement and satisfaction scores
- Outreach conversion effectiveness
- Documentation accuracy and compliance
Career Path
- Senior Quality Outreach Specialist
- Quality Campaign Specialist / SME
- Care Coordination / Population Health Lead
- Quality Operations Manager
