Member Service Advocate

Our client is driven by a shared purpose: to lead and empower healthier lives for everyone. Our colleagues are deeply committed to giving back to the communities where they live and work, and we’re looking for team members who want to be part of something bigger—an organization that values compassion, collaboration, and impact.

Under the general direction of the Service Center Supervisor, the Member Services Advocate provides exceptional customer service, navigating the complexities of the healthcare system, dressing inquiries, resolving issues and ensuring members have a positive experience. The Member Service Advocate is a member champion to resolve issues internally with a wide variety of departments and interacting externally with providers, employers, brokers and provider billing offices to assist with issue resolution.

A candidate should be proficient in working in multiple systems at once while doing real-time analysis of data and documentation to resolve member inquiries.

• Inbound Call Management
  - Handle inbound calls from members with professionalism and attentiveness, addressing inquiries related to health insurance benefits, coverage, claims and eligibility.
• Health Care System Navigation- support and advocate for members to ensure that they receive the care/support needed
• Problem Resolution
  - Provide education and guidance to members about their benefits and take ownership of each call to ensure that issues are resolved promptly and accurately. Follow up with members as needed to ensure complete resolution.
• Member Engagement
  - Assist members in understanding and accessing their benefits and educate members on how to use self-service tools, deliver proactive/anticipatory service
• Documentation and Reporting
  - Record call details and member interactions in the system accurately, ensuring that all relevant information is documented for future reference and reporting ensuring HIPPA, State and Federal regulations and confidentiality standards are met.
• Team Collaboration
  - Work collaboratively with other team members and departments to address complex issues and ensure seamless member experience.
• Member Experience
  - As a brand ambassador of our client, you will go above and beyond to ensure member satisfaction, proactively identifying and addressing needs and concerns.
• Continuous Improvement
  - Represent the voice of the customer by contributing to continuous improvement initiatives and providing feedback on member interactions and suggesting process enhancements.
• Metrics & Goals
  - Adhere to assigned schedules to ensure appropriate phone queue coverage & meet or exceed department established key performance indicators
• Member Retention & Outbound Campaigns
  - Execute outbound calls to improve the member experience and assist in member retention
• Compliance and Policy Adherence-Ensure all interactions are HIPAA compliant and adhere to state and federal regulations
• Other duties as assigned.

― what you need to perform the job.

Education, Certification and Licensure

Required:

Associate degree or equivalent work experience

Preferred:
Bachelor’s degree or equivalent work experience preferred

Experience (minimum years required):

• 0-2 years of relevant experience.

• Customer service experience in health care, call center or corporate office
• Knowledge of medical terminology.
• Prior experience training and working in a virtual/remote setting.

• Customer Service Expertise
  - Demonstrated ability to provide exceptional service, including active listening, empathy, and clear communication with members
• Empathy
  - Ability to put yourself in someone else’s shoes and demonstrate compassion.
• Product Knowledge
  - Strong understanding of health insurance products, policies, and industry regulations, or the ability to quickly learn and apply new information.
• Problem-Solving/Critical Thinking Skills
  - Adept at identifying issues, analyzing information, and providing effective solutions in a timely manner
• Communication Skills
  - Excellent verbal and written communication skills, with the ability to convey complex…