Healthcare Support Advocate

This is a fully remote position, open to applicants in United States.

📋 Description

• Manage incoming and outgoing inquiries from members and providers through phone, email, and chat.

• Initiate outreach to members regarding their benefits.

• Offer detailed information on benefits, eligibility, coverage, claims, prior authorization, billing, reimbursement policies, and provider portal assistance.

• Address inquiries, complaints, grievances, and escalations, ensuring thorough documentation and appropriate routing.

• Conduct follow-up outreach to guarantee resolution, satisfaction, and continuity of care or claim outcomes.

• Foster trust through early, consistent, and personalized engagement.

• Work collaboratively with Claims Operations, Network Operations, and Account Management teams on complex cases and service enhancement initiatives.

• Identify recurring issues, system deficiencies, and process inefficiencies and provide constructive feedback to leadership.

• Achieve targets for efficiency, productivity, quality, accuracy, customer satisfaction, compliance, follow-up completion, and attendance.

• Uphold confidentiality and adhere to HIPAA, ERISA, and XO Health policies.

⛳️ Requirements

• 3–5 years of experience in a healthcare payer, TPA, or health insurance setting, including support for contact center and member-provider interactions.

• In-depth understanding of health insurance concepts, benefits and eligibility, medical terminology, and claims lifecycle management.

• Excellent verbal and written communication skills in English.

• High level of attention to detail, sound judgment, and strong analytical problem-solving abilities.

• Capability to multitask in a fast-paced, digital-first environment while ensuring accuracy and professionalism.

• Proficient in Microsoft Office Suite and customer service and/or claims processing systems.

• Must be available to support contact center hours from 8:00am to 5:30pm ET.

• Must participate in a rotating on-call schedule for urgent member and provider assistance.

• Preferred: Associate or bachelor’s degree in healthcare administration, business, or a related field.

• Preferred: Familiarity with Availity Essentials, payer portals, and EDI standards.

• Preferred: Experience with Genesys, ServiceNow, and other CRM tools.

• Preferred: Knowledge of Facility, Physician, Ancillary, and Behavioral Health claim types.

• Spanish proficiency is an advantage.

🏝️ Benefits

• Comprehensive health insurance options.

• Retirement savings plan with company match.

• Generous paid time off and holiday schedule.

• Opportunities for professional development and career advancement.

• Supportive work environment with a focus on employee well-being.