Member Care Advocate (MCA)

The Member Care Advocate will provide high-quality member support by resolving healthcare-related questions, guiding individuals through benefit options, and ensuring a smooth experience across every interaction. This role requires empathy, strong communication skills, attention to detail, and the ability to manage a high volume of requests effectively.

• Handle inbound member calls and chats with professionalism, empathy, and clear communication.
• Help members understand healthcare benefits, including coverage details, deductibles, copays, coinsurance, out-of-pocket limits, and eligibility information.
• Assist members with locating in-network providers, updating account details, and receiving status updates on existing requests.
• Guide members through available healthcare programs, virtual care services, enrollment processes, and scheduling steps.
• Resolve member questions from start to finish by following established workflows and providing clear education to prevent future confusion.
• Use internal systems, knowledge bases, and external portals to research information and identify appropriate solutions.
• Maintain accurate documentation of member interactions, actions taken, and follow-up requirements.
• Escalate complex situations appropriately while providing clear summaries to support additional team assistance.
• Maintain high-quality service standards by meeting performance expectations related to accuracy, member satisfaction, and communication quality.
• Protect member privacy and maintain confidentiality in accordance with HIPAA requirements.

Requirements:

The ideal candidate has experience in customer service, healthcare support, or benefits navigation and is passionate about helping people access better care. Strong communication skills, critical thinking, and comfort working remotely are essential for success.

• Bachelor’s degree with at least 2 years of customer service or healthcare experience, or 5 years of relevant healthcare or benefits navigation experience.
• Experience managing a high volume of inbound calls using phone or VoIP systems.
• Strong understanding of customer service principles and the ability to advocate for members in challenging situations.
• Excellent verbal communication skills with the ability to explain healthcare processes, benefits, and next steps clearly.
• Strong written communication skills in English for accurate member documentation.
• Ability to learn and navigate CRM platforms, healthcare systems, Google Workspace, Apple products, and proprietary tools.
• Strong critical-thinking skills with the ability to identify issues, ask effective questions, and determine appropriate solutions within defined processes.
• Ability to manage sensitive information while maintaining confidentiality and HIPAA compliance.
• Reliable internet connection and ability to work from a secure, distraction-free home office.
• Strong self-management skills and ability to succeed in a remote work environment.
• Availability to complete a required 3-week paid training program from 10 a.m. to 7 p.m. EST, Monday through Friday, without planned time off.

Benefits:

• Fully remote work opportunity.
• Paid 3-week onboarding and training program.
• Competitive contractor compensation structure.
• Opportunity to support individuals in navigating important healthcare decisions.
• Mission-driven environment focused on improving healthcare access and member experiences.
• Opportunity to develop expertise in healthcare benefits, navigation, and customer advocacy.
• Access to digital tools and resources that support effective remote work.
• Collaborative environment with teams dedicated to improving care delivery.