Member Care Advocate – September Cohort

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

📋 Description

• Deliver Member-Centered Support in a High-Volume Setting:

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

• Address Core Member Concerns:

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

• Locating and verifying in-network providers, updating account details, and providing straightforward status updates on existing requests.

• Connecting members to available programs (such as virtual care) by assisting them through standard enrollment or scheduling procedures.

• Take Ownership of Issues and Empower Members:

• Resolve well-defined inquiries from start to finish using established workflows and scripts, while educating members to minimize future confusion and repeated contacts.

• Utilize Tools and Resources:

• Navigate Included Health systems, knowledge databases, and carrier portals to research inquiries and determine the appropriate next steps.

• Document interactions and follow-up activities accurately, ensuring clear, concise notes that promote continuity of care across the team.

• Deliver Consistent Quality:

• Meet or surpass expectations for quality audits and member satisfaction (MSAT), while clearly conveying Included Health's mission and commitment to reducing barriers 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.

• Comfortable managing a high volume of incoming calls throughout the day using VoIP phone systems (e.g., CXOne).

• Strong familiarity with Google Workspace, Apple products, and customer relationship management (CRM) software, along with the capability to quickly learn proprietary tools.

• Outstanding customer service skills, with the ability to serve as a member advocate, de-escalate challenging situations, and maintain a professional, 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 something appears incorrect, and utilize available resources to resolve well-defined issues.

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

• Understands and adheres to HIPAA guidelines and maintains 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 environment.

• Must be able to complete the 3-week paid training period without any planned time off. Training hours are *10 a.m. - 7 p.m. EST Monday - Friday.*

🏝️ Benefits

• Health insurance

• 401(k)

• Remote work options