Member Care Advocate (MCA)
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This is a remote position, Training is 10 a.m. - 7 p.m. ESTFull-TimeMiddle
Salary not disclosed
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Job Details
- Languages
- English
- Experience
- Bachelor's degree with a minimum of 2 years of customer service or healthcare experience, OR 5 years of relevant experience in healthcare or benefits navigation.
- Required Skills
- Customer serviceGoogle WorkspaceCRM
Requirements
- Bachelor's degree with at least 2 years of customer service or healthcare experience, or 5 years of relevant healthcare/benefits experience.
- Experience handling high volumes of inbound calls using VoIP phone systems (e.g., CXOne).
- Strong familiarity with Google Workspace, Apple products, and CRM software.
- Ability to learn proprietary internal systems quickly.
- Exceptional customer service skills with the ability to de-escalate challenging situations.
- Strong verbal communication skills to explain complex benefits and processes clearly.
- Strong written communication skills in English for accurate documentation.
- Critical thinking skills to resolve defined member issues within established workflows.
- Commitment to HIPAA compliance and member confidentiality.
- Ability to work from a secure, distraction-free home office with reliable internet.
- Ability to complete the 3-week paid training period (10 a.m. - 7 p.m. EST, Monday - Friday) with no planned time off.
Responsibilities
- Answer inbound calls and chats respectfully and empathetically to help members feel informed.
- Explain benefits coverage, cost-sharing concepts (deductibles, copays, coinsurance, out-of-pocket maximums), and eligibility details.
- Identify in-network providers, update account information, and provide status updates on requests.
- Guide members through enrollment or scheduling steps for programs like virtual care.
- Resolve member questions using established workflows while educating members to reduce future confusion.
- Navigate company systems, knowledge bases, and carrier portals to research inquiries.
- Document all interactions and follow-up actions clearly in CRM systems.
- Meet or exceed quality audit and member satisfaction (MSAT) expectations.
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