Job Title: Member Care Advocate 

Location: Remote (United States) Pay: $18.00 - $19.50 per hour (dependent on geographic location) Additional compensation for Spanish-speaking candidates

Are you a driven, empathetic individual with a passion for helping people and solving problems? Do you want to play a critical role in simplifying healthcare for members? We're seeking dedicated Member Care Advocates to join our mission to raise the standard of healthcare for everyone, everywhere.

As a Member Care Advocate, you will be the most visible representative of our mission, acting as a trusted guide to help members navigate the complexities of their healthcare benefits. You'll handle high-volume interactions, providing high-quality support and ensuring each member's journey is as seamless as possible.

What You'll Do:

• Provide Empathetic Support: Answer inbound calls and chats from members, providers, and vendors, ensuring every interaction is respectful, compassionate, and solutions-oriented.
• Advocate for Members: Take ownership of members' healthcare navigation needs, assisting with health plan-related questions including claims and billing inquiries, prior authorizations, and benefits coverage. You'll also facilitate access to virtual care services, second opinions from experts, and other vital healthcare resources.
• Own the Member Journey: Take full ownership of member issues from start to finish, meticulously researching and resolving complex cases to minimize member effort.
• Empower Members Through Education: Guide members in understanding their available benefits and help them access the services that best meet their needs.
• Leverage Resources: Research internal tools and external benefits to determine the best course of action, ensuring accurate and actionable information is always provided.
• Utilize Tools & Technology: Demonstrate proficiency with required systems to effectively navigate and document member interactions.
• Represent Our Mission: Clearly articulate our 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.

What We're Looking For:

• Education & Experience: Bachelor’s degree or 5 years of relevant experience in healthcare (preferred).
• Comfort with High-Volume Inbound Phone Work: Familiarity with VoIP phone systems (e.g., CXOne) and comfortable handling a high volume of calls throughout the day.
• Technical Proficiency: Strong familiarity with Google apps, Apple products, and customer relationship management software, with the ability to quickly adapt to proprietary tools.
• Customer Service Excellence: Exceptional customer service skills, with the ability to act as a member advocate and consistently prioritize their needs.
• Communication Skills:
• Verbal: Ability to confidently explain services, maintain a professional and friendly phone demeanor, and effectively handle challenging conversations.
• Written: Strong business writing skills in English, including accurate spelling, grammar, and clarity. Ability to communicate effectively with members and providers in writing.

• Critical Thinking & Problem-Solving: Demonstrated ability to think critically and utilize resources to problem-solve complex situations.
• Confidentiality & Compliance: Understands and follows HIPAA guidelines and regulations, maintaining member confidentiality at all times.
• Remote Work Readiness: Ability to work from a secure home office, free from distractions, with the discipline to succeed in a remote environment.

  Key Success Metrics:

  • Availability & 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.

  Work Schedule & Training:

  This is a Contract-to-Hire (CTH) position. Talent should be prepared to work 9-12 months as a contractor before being eligible for conversion to a permanent role.

  Our department operates 7 days a week. During week 3 of training, you will select your schedule. Please note that we cannot guarantee normal business hours, and you should be comfortable with your schedule varying by approximately 3 hours +/- from training hours. Most schedules will be geared towards serving our West Coast customers, with typical start times at 8 AM, 9 AM, and 10 AM PST.

  Training: This is an 8-week program, Monday-Friday from 7 AM to 4 PM Pacific Time. You will be required to pass testing throughout the training period.

  If you're ready to make a significant impact and help simplify healthcare for countless individuals, we encourage you to apply!

^*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 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.