Member Care Advocate
New
I
Included HealthHealthcare
Remote, 10 a.m. - 7 p.m. ESTContractMiddle
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 WorkspaceCritical thinkingCRM
Requirements
- 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.
- Comfortable handling a high volume of inbound calls throughout the day using VoIP phone systems (e.g., CXOne).
- Strong familiarity with Google Workspace, Apple products, and customer relationship management (CRM) software.
- Exceptional customer service skills with the ability to act as a member advocate and de-escalate challenging situations.
- Strong verbal communication skills for phone interactions, including the ability to explain benefits clearly.
- Strong written communication skills in English for accurate, clear documentation of member interactions.
- Demonstrated ability to think critically within defined workflows to resolve well-scoped issues.
- Understand and follow HIPAA guidelines and maintain member confidentiality at all times.
- Ability to work from a secure, distraction-free home office with reliable internet.
- Must be able to complete the mandatory 3-week paid training period (10 a.m. - 7 p.m. EST, M-F) with no planned time off.
Responsibilities
- Answer inbound calls and chats respectfully and empathetically, using clear, plain language to help members feel confident and informed.
- Explain benefits coverage, cost-sharing concepts (deductibles, copays, coinsurance, and out-of-pocket maximums), and basic eligibility details.
- Find and confirm in-network providers, update account information, and provide simple status updates on existing requests.
- Connect members to available programs (such as virtual care) by guiding them through standard enrollment or scheduling steps.
- Resolve clearly defined questions end-to-end using established workflows and scripting while educating members.
- Navigate Included Health systems, knowledge bases, and carrier portals to research questions and identify the right next step.
- Accurately document interactions and follow-up actions in CRM systems to ensure continuity of care.
- Meet or exceed expectations for quality audits and member satisfaction (MSAT).
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