Member Care Advocate, MCA

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

📋 Description

• Deliver member-focused assistance in a fast-paced environment:

• - Respond to inbound calls and chats with respect and empathy, utilizing clear and straightforward language to ensure members feel informed and confident.

• Address core member inquiries:

• - Clarify benefits coverage, cost-sharing concepts (deductibles, copays, coinsurance, and out-of-pocket maximums), and essential eligibility information.

• - Locate and verify in-network providers, update account details, and offer straightforward status updates on current requests.

• - Assist members in connecting with available programs (such as virtual care) by guiding them through standard enrollment or scheduling processes.

• Take ownership of issues and empower members:

• - Resolve clearly defined inquiries from start to finish by following established workflows and scripts, while educating members to minimize future confusion and repeat contacts.

• Utilize tools and resources effectively:

• - Navigate Included Health systems, knowledge bases, and carrier portals to investigate inquiries and determine the appropriate next steps.

• - Meticulously document interactions and follow-up actions, ensuring clear and concise notes that facilitate continuity of care across the team.

• Provide consistent quality service:

• - Meet or surpass expectations for quality audits and member satisfaction (MSAT), while effectively communicating Included Health's mission and dedication to reducing friction in healthcare.

⛳️ Requirements

• A bachelor's degree with at least 2 years of customer service or healthcare experience, **OR** 5 years of pertinent experience in healthcare or benefits navigation.

• Proficient in managing 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, with the capacity to quickly learn proprietary tools.

• Outstanding customer service skills, capable of acting as a member advocate, de-escalating challenging situations, and maintaining a professional and friendly demeanor.

• Excellent verbal communication skills for phone interactions, including the ability to clearly and confidently explain benefits, processes, and next steps.

• Strong written communication skills in English for accurate and clear documentation of member interactions.

• Proven ability to think critically within defined workflows, recognize when issues arise, and utilize available resources to resolve well-scoped problems.

• Comfortable gathering information, asking clarifying questions, and structuring a clear summary when additional follow-up from other teams is necessary.

• Knowledge of and adherence to HIPAA guidelines, maintaining member confidentiality at all times.

• Ability to work from a secure, distraction-free home office with reliable internet, and the discipline to thrive in a remote setting.

• Must complete a 3-week paid training period with no planned time off allowed. Training is *10 a.m. - 7 p.m. EST Monday - Friday.*

🏝️ Benefits

• Included Health is an Equal Opportunity Employer.

• 3-week paid training period.

• Remote position requires a secure, distraction-free home office.