Member Care Advocate, MCA

🔥 0 minutes ago

🇺🇸 United States – Remote

⏳ Contract/Temporary

🟢 Junior

🟡 Mid-level

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Included Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

☁️ SaaS

🤝 B2B

👥 HR Tech

SaaS • B2B • HR Tech

Included Health is a healthcare technology company that delivers personalized, employer- and health-plan-focused primary, urgent, and behavioral health care through a single app and a network of virtual and in-person services. It blends AI-driven tools and human care teams to provide 24/7 care coordination, billing and claims advocacy, second opinions from leading specialists, and mental-health support, with the goal of lowering employer healthcare costs and improving member experience and inclusivity.

📋 Description

• 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.

🎯 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