Member Care Advocate, Bilingual

Role Overview

• You will answer a high volume of inbound calls from English and Spanish-speaking members, providers, and vendors, ensuring every interaction is respectful, compassionate, and solution-oriented.
• You will be a part of a team that manages all member inquiries, utilizing all available resources to provide precise, accurate information and aiming for first-call resolution
• minimizing member effort.
• You will own the member's journey, including researching and resolving complex cases, answering health plan-related questions, billing and claims inquiries, prior authorizations, and benefits coverage questions.
• You will guide members in accessing the services that best meet their needs. This includes facilitating access to virtual care services, obtaining second opinions from experts, and connecting members to other valuable healthcare resources. For clinical opportunities, you will be tasked with internal routing and ensuring the member's continuity of care.
• You will clearly explain all available benefits and help members understand their healthcare options in their preferred language, ensuring they are well-informed to make the best decisions for their health.
• You will expertly utilize VoIP phone systems (e.g., CXOne), Google apps, Apple products, and customer relationship management (CRM) software, to navigate and document member interactions.
• You will articulate Included Health's mission and understand the scope of our services to deliver consistent, high-quality advocacy to members.
• You will ensure every interaction is high-quality and provide service that is perceptive, skilled, and focuses on our members.

Requirements

• Bilingual proficiency; full fluency in both English and Spanish is required.
• Bachelor's degree with 2 years of healthcare experience, OR 5 years of relevant experience in healthcare field.
• Experience using VoIP phone systems (e.g., CXOne) AND comfortable handling a high volume of calls the entire day.
• Robust knowledge with Google apps, Apple products, and customer relationship management software, with proven ability adapting to proprietary tools.
• Must be able to complete the 8-week paid training period with no planned time off permitted. Training is *10 a.m.
• 7 p.m. EST Monday
• Friday.*

Tech Stack

• VoIP

Benefits

• Medical and Dental, will be provided and managed by Contracting Agency.
• Excellent medical, dental, and vision insurance, plus extensive benefits through our own product (IH4IH) from day one including free virtual primary care, urgent care, and behavioral health.
• Support via our Employee Assistance Program and the Golden Ticket program for family and friends.
• A work-from-home (WFH) stipend to cover your internet expenses and a 401(k) plan with a 50% match on your contributions, up to 6%.
• Paid time off, generous parental leave, company-wide holidays, and paid volunteer time.
• Numerous opportunities for career advancement and professional development.