Member Care Advocate II

Summary

Join Included Health as a Communities Member Care Advocate and become a visible representative of our mission to elevate healthcare standards. You will provide personalized service to Black community members via phone and chat, connecting them with culturally affirming providers, answering healthcare benefit questions, initiating services, and navigating healthcare complexities. This role involves administrative, financial, and clinical support, requiring strong communication and advocacy skills. You will collaborate with colleagues, leadership, and other departments to ensure optimal member care. The position offers a competitive salary and a comprehensive benefits package, including remote work options.

Requirements

• Exceptional business writing skills in English, including proficiency in spelling and grammar, and excellent verbal skills (you will need to explain our services with confidence and a friendly telephone demeanor)
• Proficiency with Google Apps, Apple Products, and Customer Relationship Management Software
• Familiarity and comfortability with Voice-over-IP (VoIP) phone systems (e.g. CXOne) and communicating through such systems for a majority of the work day
• Bachelor's degree or 2+ years of relevant work experience in healthcare, advocacy, or benefits/insurance organization
• Successful at handling confidentiality, security, and HIPAA guidelines and regulations
• Prompt and regular attendance at assigned work location
• Capability to remain seated in a stationary position for prolonged periods
• Eye-hand coordination and manual dexterity to operate keyboard, computer and other office-related equipment
• No heavy lifting is expected, though occasional exertion of about 20 lbs of force (e.g., lifting a computer / laptop) may be required
• Capability to work with leadership, employees, and members in an appropriate manner

Responsibilities

• Provide administrative, financial, and clinical support with empathy and respect
• Answer member calls; communicate with members by Phone and Chat; advocate with insurance companies and community healthcare providers to resolve medical billing problems; and research available benefits to identify the optimal resolution for the member
• Collect, capture and document information gained in member interactions, including demographic and insurance information
• Contribute to the provider directory by researching and contacting providers to ask a series of questions to collect comprehensive data about their practice and to evaluate if the provider is high-quality and provides culturally competent & affirming care
• Advocate and navigate members, including finding new providers for members and assisting with locating resources and addressing Social Determinants of Health
• Educate members on their benefits coverage, including when to consider using their benefits, and how to use their benefits
• Triages/support claims and billing inquiries, prior authorizations, and other support questions
• Connect members to IH clinical services, including virtual care services and second opinions
• Uphold IH's mission of raising "The Standard of Healthcare for Everyone"
• Collaborate with other Member Care Advocates, Leadership, and other departments on specific member healthcare journeys

Benefits

• Remote-first culture
• 401(k) savings plan through Fidelity
• Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance)
• Paid Time Off ("PTO") and Discretionary Time Off ("DTO")
• 12 weeks of 100% Paid Parental leave
• Family Building & Compassionate Leave: Fertility coverage, $25,000 for surrogacy/adoption, and paid leave for failed treatments, adoption or pregnancies
• Work-From-Home reimbursement to support team collaboration home office work