Member Care Advocate
Remote
Ops/Member Care – Member Care /
Contractor /
Remote
Job Summary:
At Included Health, our mission is to raise the standard of healthcare for everyone. As a Member Care Advocate, you will be a highly visible representative of this mission, acting as a trusted guide to help members navigate the complexities of their healthcare benefits. This role is critical in simplifying healthcare for our members by handling high-volume interactions and owning their healthcare journey from start to finish, reporting directly to the Member Advocacy team.
This is a remote position, requiring a secure and distraction-free home office.
Responsibilities:
- Provide Empathetic and Comprehensive Support: Answer a high volume of inbound calls and chats from members, providers, and vendors, ensuring every interaction is respectful, compassionate, and solutions-oriented. You will manage all inquiries, aiming for first-call resolution whenever possible, rather than transferring.
- Own the Member Journey: This includes researching and resolving complex cases to minimize member effort. You will be the primary point of contact, ensuring all aspects of the member's needs are addressed without unnecessary handoffs.
- Navigate Complex Healthcare Needs: Assist members in resolving all health plan-related questions, including intricate claims and billing inquiries, prior authorizations, and detailed benefits coverage explanations. You will delve deep into member issues utilizing all available resources to provide accurate and actionable information.
- Facilitate Access to Care: Guide members in accessing the services that best meet their needs. This includes facilitating access to virtual care services, obtaining second opinions from experts, and connecting members to other valuable healthcare resources. For clinical opportunities, you will be responsible for internal routing and ensuring the member's continuity of care.
- Empower Members through Education: Clearly explain available benefits and help members understand their healthcare options, ensuring they are well-informed to make the best decisions for their health.
- Utilize Resources and Technology: Proficiently leverage internal tools and external benefits information to determine the best course of action. You will demonstrate proficiency with required systems, including VoIP phone systems (e.g., CXOne) , Google apps, Apple products, and customer relationship management (CRM) software, to navigate and document member interactions effectively.
- Represent Our 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 high-quality standards, focusing on delivering empathetic, efficient, and member-focused service. Your goal is to provide a high degree of satisfaction for members.
Qualifications:
- Education and Experience: Bachelor's degree with 2 years of healthcare experience, or 5 years of relevant experience in healthcare (preferred).
- High-Volume Inbound Calls: With VoIP phone systems (e.g., CXOne) and comfortable handling a high volume of calls the entire day.
- Technical Proficiency: Strong familiarity with Google apps, Apple products, and customer relationship management software, with the ability to adapt to proprietary tools quickly.
Physical/Cognitive Requirements:
- Capability to remain seated in a stationary position for prolonged periods.
- Eye-hand coordination and manual dexterity to operate keyboard, computer and other office-related equipment.
- Capability to work with leadership, employees, and members in an appropriate manner.
Pay:
The United States new hire hourly rate for this contract position is: $21.00
Benefits: Medical and Dental, will be provided and managed by Contracting Agency
About Included Health
Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We're on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It's all included. Learn more at includedhealth.com.
Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants with arrest or conviction records in accordance with the San Francisco Fair Chance Ordinance, the Los Angeles County Fair Chance Ordinance, and California law.
About Included Health
Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com.
-----
Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants with arrest or conviction records in accordance with the San Francisco Fair Chance Ordinance, the Los Angeles County Fair Chance Ordinance, and California law.
