Remote Member Care Advocate

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. Member Care Advocates are the most visible representatives of our mission to raise the standard of healthcare for everyone, everywhere. 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 the required systems to navigate and document member interactions effectively
* Represent the mission: Clearly articulate their 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

Key Success Metrics
* Availability and adherence: Maintain a consistent presence for members while adhering to an assigned schedule.
* Quality of Interactions: Demonstrate high standards in service, performance on audits, and member satisfaction surveys.
* Impactful Advocacy: Effectively represent member needs, connect them to valuable resources, and champion their healthcare journey.

Required Experience
* Healthcare customer service (insurance knowledge and reading a healthcare plan is required)
* Bachelor's degree or 5 years relevant experience in healthcare (preferred)
* Insurance and Claims Backgrounds (preferred)
* Remote Call Center experience (preferred)

Schedule
* Department is open 7 days a week
* M-F schedules with hours ranging with a 4:00am PST - 10:00am PST start time, additional weekend coverage shifts will be offered

Pay
* $18.00 to $19.50 (rate varies by state; non-negotiable)

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.