Job Description
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
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
💡 Quick Summary
Seeking a career-building opportunity? The Quality Outreach Specialist position is now open for candidates interested in the BPO Jobs sector. This role in Mumbai offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in BPO Jobs is a plus.