Member Services Advocate

Job Summary Under the general direction of the Service Center Supervisor, the Member Services Advocate provides exceptional customer service, navigating the complexities of the healthcare system, resolving inquiries, and ensuring members have a positive experience. Responsibilities Handle inbound calls from members with professionalism, addressing inquiries related to health insurance benefits, coverage, claims, and eligibility. Support and advocate for members to ensure they receive the necessary care and support. Provide education and guidance about Point32Health benefits, taking ownership of each call to ensure prompt and accurate resolution. Follow up with members as needed to ensure complete resolution. Assist members in understanding and accessing their benefits and educate them on how to use self‑service tools. Record call details and member interactions in the system accurately, ensuring compliance with HIPAA, state, and federal regulations. Collaborate with team members and departments to address complex issues and ensure a seamless member experience. Act as a brand ambassador, proactively identifying and addressing member needs and concerns. Contribute to continuous improvement initiatives by providing feedback on member interactions and suggesting process enhancements. Adhere to assigned schedules to ensure appropriate phone queue coverage and meet or exceed key performance indicators. Execute outbound calls to improve the member experience and assist in member retention. Ensure all interactions are HIPAA compliant and adhere to state and federal regulations. Perform other duties as assigned. Qualifications Associate degree or equivalent work experience (Bachelor’s degree preferred). 0–2 years of relevant experience; preferred customer service experience in health care, call center, or corporate office. Knowledge of medical terminology. Prior experience training and working in a virtual/remote setting. Skills Customer Service Expertise – active listening, empathy, clear communication. Empathy – ability to understand and demonstrate compassion. Product Knowledge – strong understanding of health insurance products, policies, and industry regulations. Problem‑Solving/Critical Thinking – identify issues, analyze information, provide solutions promptly. Communication – excellent verbal and written skills. Attention to Detail – high accuracy in handling member information. Multitasking – manage multiple tasks simultaneously while maintaining focus. Technical Proficiency – comfortable using computer systems, CRM software, and related technology. Adaptability – adjust to changing priorities and new processes. Team Collaboration – work effectively with team members and foster a positive environment. Conflict Resolution – manage and resolve conflicts with professionalism and patience. Working Conditions Work under normal office conditions and from home as required. The role may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations. May require additional hours beyond the standard schedule. Salary Base salary range: $22.00 – $22.00 per hour. Benefits Medical, dental, and vision coverage Retirement plans Paid time off Employer‑paid life and disability insurance with additional buy‑up coverage options Tuition reimbursement program Well‑being benefits Full suite of benefits to support career development, individual and family health, and financial health Equal Employment Opportunity Statement We welcome all applicants and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. #J-18808-Ljbffr