Member Care Advocate (MCA) - Remote

Included Health is on a mission to raise the standard of healthcare for everyone by simplifying access through virtual and in-person care, expert navigation, and technology-driven support.

The Member Care Advocates (MCAs) are key representatives of this mission, helping members feel seen, supported, and confident in navigating their healthcare benefits and care options. MCAs act as trusted guides, addressing fundamental healthcare benefit questions and delivering high-quality, empathetic support in a high-volume environment.

New MCA hires undergo a 3-week paid training period with a strict schedule of 10 a.m. - 7 p.m. EST, Monday - Friday. No planned time off is permitted during training. The start date for this role is 11/16. This is a remote position requiring a secure, distraction-free home office.

Responsibilities

• Provide Member-Centered Support in a High-Volume Environment:
• Answer inbound calls and chats with clear, plain language to empower members with confidence and information.
• Resolve Core Member Issues:
• Explain benefits coverage, cost-sharing concepts (deductibles, copays, coinsurance, and out-of-pocket maximums), and basic eligibility details.
• Find and confirm in-network providers, update account information, and provide status updates on existing requests.
• Connect members to programs like virtual care by guiding them through enrollment or scheduling steps.
• Own Issues and Empower Members:
• Resolve end-to-end questions using established workflows and scripting, while educating members to reduce future confusion and repeat contacts.
• Leverage Tools and Resources:
• Navigate Included Health systems, knowledge bases, and carrier portals to research questions and identify next steps.
• Document interactions and follow-up actions with clear, concise notes for continuity of care.
• Deliver Consistent Quality:
• Meet or exceed quality audit and member satisfaction (MSAT) expectations while articulating Included Health’s mission to reduce healthcare friction.

Qualifications

• A Bachelor's degree with 2+ years of customer service or healthcare experience, OR 5+ years of relevant healthcare or benefits navigation experience.
• Ability to handle a high volume of inbound calls using VoIP systems (e.g., CXOne).
• Strong familiarity with Google Workspace, Apple products, and CRM software, with quick adaptability to proprietary tools.
• Exceptional customer service skills, including advocacy, de-escalation, and maintaining a professional demeanor.
• Clear verbal communication for phone interactions, explaining benefits, processes, and next steps confidently.
• Accurate written communication in English for documenting member interactions.
• Critical thinking within defined workflows, identifying issues and resolving well-scoped problems.
• Ability to gather information, ask clarifying questions, and summarize for follow-up.
• Compliance with HIPAA guidelines and strict member confidentiality.
• Self-discipline for remote work with a secure, distraction-free home office and reliable internet.
• Commitment to complete the 3-week paid training period with no planned time off.