Member Care Advocate

Job Summary:

As a Member Care Advocate, you'll act as a trusted guide, helping members navigate the complexities of their healthcare benefits while delivering high-quality support. In this role, you will handle high-volume interactions and play a critical part in simplifying healthcare for members. If you're a driven, empathetic individual with a strong interest In helping people and solving problems, we want to hear from you.

Responsibilities:

• Provide empathetic support: Answer inbound calls and chats from members, providers, and vendors, ensuring each interaction is respectful, compassionate, and solutions-oriented
• Advocate for members by taking ownership of their healthcare navigation needs , including:
• Assist members in resolving health plan-related questions, including claims and billing inquiries, prior authorizations, and benefits coverage.
• Facilitate access to virtual care services, second opinions from an expert, and other healthcare resources.
• Own the member journey: Take full ownership of member issues from start to finish, researching and resolving complex cases to minimize member effort
• Empower members through education: Help members understand their available benefits and guide them in accessing the services that best meet their needs
• Leverage internal and external resources: Research internal tools and external benefits to determine the best course of action, ensuring accurate and actionable information is provided
• Utilize tools and technology: Demonstrate proficiency with Included Health's required systems to navigate and document member interactions effectively
• Represent the mission: Clearly articulate Included Health's mission and fully understand the scope of our services to deliver consistent, high-quality advocacy
• Drive member satisfaction: Ensure all interactions meet quality standards, focusing on delivering empathetic, efficient, and member-focused service

Qualifications:

• Education and experience: Bachelor's degree or 5 years relevant experience in healthcare (preferred)
• Comfort with high-volume inbound phone work: Familiarity with VoIP phone systems (e.g., CXOne) and comfortable handling a high volume of calls l throughout the entire day
• Technical proficiency: Strong familiarity with with Google apps, Apple products, and customer relationship management software, and ability to adapt to proprietary tools quickly
• Customer service excellence:Exceptional customer service skills, with the ability to act as a member advocate and prioritize their needs.

Communication skills:

• Verbal: Ability to confidently explain services, maintain a professional and friendly phone demeanor, and handle challenging conversations effectively.
• Written: Strong business writing skills in English, including accurate spelling, grammar, and clarity. Ability to communicate with members and providers in writing.
• Critical thinking and problem-solving: Demonstrated ability to think critically and use your resources to problem solve complex situations
• Confidentiality and compliance: Understands and follows HIPAA guidelines and regulations and maintains member confidentiality at all times
• Remote work readiness: Ability to work from a secure home office, free from distractions, with the discipline to succeed in a remote environment

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.