Independent Member Advocate - Hybrid (Medfield, MA)

Summary

As an Independent Member Advocate, you will be the first point of contact for our clients’ employees providing concierge service support via phone and emails. Your role is to ensure a positive member experience by addressing benefit inquiries, educating members on available resources and resolving claims/service provider billing issues efficiently.

Essential Duties and Responsibilities

• Manage high volume of incoming calls and emails explaining healthcare plan benefits, assisting members with locating in-network physicians/facilities, educating members on available self-help resources maintaining 90% or above in answered calls.
• Outbound calls to provide eligibility/benefit information to healthcare service providers, advocating for member with health care provider, pharmacy, insurance carrier to resolve problems quickly and efficiently.
• Troubleshoot debit card declines and online portal access.
• Identify eligibility or claims errors, and collaborate with other departments for correction to ensure a seamless member experience.
• Review book of business prior to renewal to revise client/member contact sheets and renewal materials to include Benefits Guide, benefit summaries, medical funding sheets in conjunction with built plans.
• Verify eligibility and benefits for healthcare providers and inquiries regarding claim payments and remittances.
• Document call and email interactions according to standard procedure.
• Respond to incoming email inquiries efficiently and timely with follow-ups according to standard procedure.
• Escalate complex issues to higher-level representatives when necessary.
• Build and retain relationships with plan members and clients.
• Maintain 3 or above on CSAT Phone surveys.

Qualifications, Skills and Requirements

• High school diploma or equivalent.
• Basic customer service skills with a friendly, professional demeanor.
• Strong communication and interpersonal skills.
• Willingness to learn and adapt to new processes.
• Ability to thrive in a fast-paced environment.
• Reliability, punctuality, and the ability to manage time efficiently while handling multiple duties at once.

Education, Training and Experience

• 6 months to 2 Years of customer service experience in group benefits: 2 years is preferred.
• Knowledge of healthcare benefits and the ability to communicate information to members.
• Proficient in Microsoft Outlook, Word, Excel and PowerPoint.

Pay

The typical base pay range for this role nationwide is $28 to $32 per hour. Your base pay is dependent upon your skills, education, qualifications, professional experience, and location. In addition to base pay, some roles are eligible for variable compensation, commission, and/or annual bonus based on your individual performance and/or the company’s performance.

Benefits

• Health, wellbeing, retirement, and other financial benefits.
• Paid time off.
• Overtime pay for non-exempt employees.
• Robust learning and development programs.
• You will receive reimbursement of job-related expenses per the company policy and may receive employee perks and discounts.

About the Role

We are a people-focused organization that helps over 100,000 employers give their employees peace of mind by providing health, pharmacy, long and short-term disability, vision, dental and other insurance solutions. We are unique because we can surround our clients with more services and more technology-based tools and a team of advisors that cares more than anyone else.

Schedule

Your schedule will vary based on the needs of our clients and the demands of your role. We strive to provide a flexible work environment that supports your personal and professional goals.

Skills

• Customer service skills.
• Communication and interpersonal skills.
• Problem-solving abilities.
• Time management skills.
• Adaptability and willingness to learn.

Benefits

• Healthcare coverage.
• Retirement savings options.
• Flexible scheduling.
• Professional development opportunities.
• Work-life balance.

Equal Opportunity Employer

We are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We are an equal opportunity employer and do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, veteran status, or any other characteristic protected by law.