Included Health logo
Included Health

Access. Answers. Advocacy. We're raising the standard of healthcare for everyone.

Member Care Advocate, MCA

Location

United States

Posted

7 days ago

Salary

0

Seniority

Mid Level

Bachelor Degree2 yrs expEnglishVoIP

Job Description

Member Care Advocate, MCA

Included Health

• Provide Member-Centered Support in a High-Volume Environment: - Answer inbound calls and chats respectfully and empathetically, using clear, plain language to help members feel confident and informed. • Resolve Core Member Issues: - Explaining benefits coverage, cost-sharing concepts (deductibles, copays, coinsurance, and out-of-pocket maximums), and basic eligibility details. - Finding and confirming in-network providers, updating account information, and providing simple status updates on existing requests. - Connecting members to available programs (such as virtual care) by guiding them through standard enrollment or scheduling steps. • Own Issues and Empower Members: - Resolve clearly defined questions end-to-end using established workflows and scripting, while educating members to reduce future confusion and repeat contacts. • Leverage Tools and Resources: - 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, ensuring clear, concise notes that enable continuity of care across the team. • Deliver Consistent Quality: - Meet or exceed expectations for quality audits and member satisfaction (MSAT), while clearly articulating Included Health's mission and commitment to reducing friction in healthcare.

Job 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, with the ability to learn proprietary tools quickly.
  • Exceptional customer service skills, with the ability to act as a member advocate, de-escalate challenging situations, and maintain a professional, friendly demeanor.
  • Strong verbal communication skills for phone interactions, including the ability to explain benefits, processes, and next steps clearly and confidently.
  • Strong written communication skills in English for accurate, clear documentation of member interactions.
  • Demonstrated ability to think critically within defined workflows, identify when something doesn't look right, and use available resources to resolve well-scoped issues.
  • Comfortable gathering information, asking clarifying questions, and structuring a clear summary when additional follow-up by other teams is needed.
  • Understands and follows 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 succeed in a remote environment.
  • Must be able to complete the 3-week paid training period with no planned time off permitted. 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

Related Job Pages

More Care Advocate Jobs

Evry Health logo

Care Guide Advocate

Evry Health

Bringing humanity to health insurance

Care Advocate8 days ago
Full TimeRemoteTeam 51-200Since 2017H1B No Sponsor

• Provide a high degree of customer service and professionalism when interacting with the patients of providers via the phone or email; ability to empathize and diffuse difficult situations professionally and in a caring manner • Assist members with detailed provider searches utilizing network look-up tools • Assist members navigating our digital programs and serve as a conduit for escalations and questions • Contact provider offices or facilities to obtain needed prior authorization pieces such as additional medical records, forms, facility location or Tax ID numbers for claims billing • Assist with claims work such as adjusting site of service • Protect/observe patient privacy and confidentiality, per external regulatory requirements (HIPAA) and internal policy and procedures • Ensures compliance with applicable URAC and NCQA accreditation guidelines and state and federal regulations

United States