Member Care Advocate (MCA)

Overview

Included Health aims to elevate healthcare standards by providing accessible, integrated virtual and in-person services combined with expert guidance and user-friendly technology, ensuring members receive appropriate care at optimal times.

Member Care Advocates (MCAs) are pivotal representatives who help members feel acknowledged and supported as they navigate healthcare benefits. MCAs serve as trusted guides through healthcare fundamentals, delivering empathetic, high-quality assistance in a busy environment, demanding strong critical thinking and initiative.

Responsibilities

• Handle high volumes of inbound calls and chats with empathy and clarity to instill confidence in members about their healthcare benefits.
• Clarify benefit coverage details, including cost-sharing components like deductibles, copays, coinsurance, and out-of-pocket limits, and provide basic eligibility information.
• Assist members in identifying and confirming in-network providers, updating their account details, and giving status updates on current requests.
• Guide members toward various available programs, such as virtual care, including step-by-step enrollment or appointment scheduling instructions.
• Take ownership in resolving straightforward queries fully by following established procedures and educating members to minimize future issues.
• Utilize Included Health systems, knowledge bases, and insurance carrier portals to research inquiries and determine appropriate actions.
• Document interactions and follow-up actions precisely to ensure seamless care coordination within the team.
• Consistently meet or surpass quality and member satisfaction benchmarks while effectively communicating Included Health's mission to reduce healthcare complexities.

Qualifications

• A bachelor's degree with at least two years of experience in customer service or healthcare, or five years of relevant healthcare or benefits navigation experience.
• Comfortable managing numerous daily inbound calls via VoIP systems like CXOne.
• Proficient in Google Workspace, Apple devices, and CRM platforms, with ability to quickly adapt to proprietary tools.
• Excellent customer service aptitude, adept at advocating for members, de-escalating difficult situations, and maintaining professionalism and friendliness.
• Strong oral communication skills for phone conversations, capable of clearly explaining benefits, procedures, and next steps.
• Strong written communication skills in English to accurately document member interactions.
• Critical thinking within set workflows to identify inconsistencies and resolve well-defined issues using available resources.
• Able to collect relevant information, ask clarifying questions, and provide clear summaries for follow-ups by other teams.
• Knowledge and adherence to HIPAA regulations and maintenance of member confidentiality.
• Ability to work from a secure, distraction-free home office with reliable internet and the discipline required for remote work.
• Commitment to completing a mandatory 3-week paid training schedule (Monday-Friday, 10 a.m.–7 p.m. EST) with no approved planned absences.

Additional Information

This position is fully remote and requires a secure, dedicated home workspace with dependable internet. The initial training is strictly scheduled, and employees must adhere to attendance policies during this period.

Included Health provides an inclusive work environment, promoting equal opportunity without discrimination based on race, gender, age, or other protected characteristics, and considers applicants with criminal records fairly in line with applicable laws.

As part of the hiring process, Included Health uses AI-supported tools to improve recruitment efficiency and communication, though final hiring decisions rest solely with human recruiters.