Member Services Advocate

Role overview

Help health plan members and healthcare providers get clear, practical support with insurance questions. You’ll handle incoming calls and emails, explain coverage and claims, and coordinate with other teams to resolve issues while providing a patient, empathetic service experience.

Responsibilities

- Respond to member and provider inquiries by phone and email, clarifying the issue and explaining next steps. - Use internal systems to answer questions about benefits, eligibility, claims, billing, provider networks, and prescriptions. - Document interactions accurately in a customer relationship management system and protect confidential information under applicable privacy requirements. - Coordinate with internal teams, vendors, and brokers or navigators to resolve complex questions. - Meet service quality and productivity expectations, including call handling, customer satisfaction, and follow-up work. - Follow a structured schedule; extended hours may be needed during the January–March peak season.

Requirements

- 1–2 years of customer service or call center experience. - Strong listening, empathy, and problem-solving skills, including the ability to address complex concerns. - Clear written and verbal communication, with the ability to summarize information accurately. - Reliability, organization, attention to detail, and the ability to follow established processes. - Comfort entering information into databases and working across multiple computer systems while speaking with customers. - Ability to learn quickly and work independently with people from varied backgrounds in a fast-paced environment.

Nice to have

- Experience in healthcare or health insurance, including Medicare, Medicaid, or Marketplace plans. - Familiarity with office productivity tools or a health insurance producer license; willingness to obtain a license if required.

Benefits and work setup

- Remote role requiring a quiet workspace and reliable high-speed internet. - Benefits include health and wellness coverage, flexible paid time off, paid holidays, parental leave of up to 16 weeks, retirement savings, education reimbursement, transportation perks, and paid leave for pet care.