Member Care Advocate (MCA)

Responsibilities

• Provide Member-Centered Support in a High-Volume Environment:

  Answer inbound calls and chats respectfully and empathetically, using clear, plain language to help members feel confident and informed.

• Resolve Core Member Issues:

  • Explaining benefits coverage, cost-sharing concepts ( deductibles, copays, coinsurance, and out-of-pocket maximums ), and basic eligibility details.
  • Finding and confirming in-network providers, updating account information, and providing simple status updates on existing requests.
  • Connecting members to available programs (such as virtual care) by guiding them through standard enrollment or scheduling steps.

• Own Issues and Empower Members:

  Resolve clearly defined questions end-to-end 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 the right next step.
  • Accurately document interactions and follow-up actions, ensuring clear, concise notes that enable continuity of care across the team.

• Deliver Consistent Quality:

  Meet or exceed expectations for quality audits and member satisfaction ( MSAT ), while clearly articulating Included Health's mission and commitment to reducing friction in healthcare.

Qualifications

• Bachelor's degree with a minimum of 2 years of customer service or healthcare experience , OR 5 years of relevant experience in healthcare or benefits navigation .
• Comfortable handling a high volume of inbound calls throughout the day using VoIP phone systems (e.g., CXOne ).
• Strong familiarity with Google Workspace, Apple products, and customer relationship management (CRM) software , with the ability to learn proprietary tools quickly.
• Exceptional customer service skills, with the ability to act as a member advocate, de-escalate challenging situations, and maintain a professional, friendly demeanor.
• Strong verbal communication skills for phone interactions, including the ability to explain benefits, processes, and next steps clearly and confidently.
• Strong written communication skills in English for accurate, clear documentation of member interactions.
• Demonstrated ability to think critically within defined workflows, identify when something doesn't look right, and use available resources to resolve well-scoped issues.
• Comfortable gathering information, asking clarifying questions, and structuring a clear summary when additional follow-up by other teams is needed.
• Understands and follows HIPAA guidelines and maintains member confidentiality at all times.
• Ability to work from a secure, distraction-free home office with reliable internet, and the discipline to succeed in a remote environment.
• Must be able to complete the 3-week paid training period with no planned time off permitted. Training is 10 a.m. - 7 p.m. EST Monday - Friday .