Remote Member Benefits Advocate

Job Description

A Day in the Life: The Member Benefit Advocate is responsible for all inbound phone, chat, and email intake for one line of business. This communication comes from both health plan members and providers and can include, but is not limited to, quotation of benefits, eligibility inquiries, claim status, balance billing situations, member plan education, member physician or facility access issues, and other claim-related billing questions. Member Benefit Advocates are responsible for providing members and providers with requested information in a clear, timely, and professional manner. The team member is responsible for making outbound calls to providers, clients, and TPA partners to gather appropriate information or submit requests as needed to reach a timely resolution. The Member Benefit Advocate will also attend various meetings and training sessions to ensure they are fully capable and up to date on job roles and responsibilities.

• Service members as they navigate their employer sponsored healthcare plans by quoting benefits, interpreting plan documents, answering questions regarding claim status and Explanation of Benefit (EOB) documents, and assisting in finding quality care providers.
• Service providers by providing eligibility verification, quoting benefits, and answering questions regarding claim status and pricing inquiries. Additionally, will work with providers on behalf of members to resolve payment-related inquiries.

Schedule Training schedule: 8:00 AM–5:00 PM Central Time Post-training schedule: 10:00 AM–7:00 PM Central Time

Skills and Requirements

2-4 years of experience working for TPAs or insurance carriers as a Member Benefits Advocate Strong work ethic High standard for attention to detail Naturally compassionate and easily able to navigate sensitive, challenging situations with care High School diploma or equivalent required Experience quoting benefits, specifically medical, dental, or vision benefits Call center experience Ideally experience in a healthcare call center environment Comfort with a high volume of inbound calls Ability and willingness to travel for onboarding/training and occasional team needs Bilingual English/Spanish Prior healthcare member services experience CRM or ticketing/case-management system experience Experience with eligibility verification, claims, provider support, or member services, as long as the candidate also has strong inbound customer/member-facing experience Bilingual English/Spanish Prior healthcare member services experience CRM or ticketing/case-management system experience Experience with eligibility verification, claims, provider support, or member services, as long as the candidate also has strong inbound customer/member-facing experience

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to [email protected].