Member Benefits Advocate - Fairos (On-Site if local to Amarillo) [Remote in Lubbock, Dallas, OKC, Tulsa, ABQ, Las Vegas]

Duties & Responsibilities

• Uphold best-in-class member experiences by owning the end-to-end resolution process, which includes thoughtfully guiding members throughout their healthcare journey.
• Practice TOC's "outward mindset" philosophy through providing empathic support to members, remaining conscious of their unique situations and needs.
• Service members as they navigate their employer sponsored healthcare plans by quoting benefits, interpreting plan documents, answering questions regarding claim status and Explanation of Benefit (EOB) documents, and assisting in finding quality care providers.
• Service providers by providing eligibility verification, quoting benefits, and answering questions regarding claim status and pricing inquiries. Additionally, will work with providers on behalf of members to resolve payment-related inquiries.
• Proactively anticipate the needs of members and offer solutions that support and enhance the member experience.
• Work across cross-functional teams, including Account Management and Contracting, to establish processes that relieve any challenges members are facing.
• Uphold compliance and confidentiality standards relating to HIPAA and Department of Labor guidelines when corresponding with members or providers and maintaining documentation.
• Perform other duties as assigned.

Requirements

• A high school diploma or equivalent required.
• Bilingual verbal and written fluency in English and Spanish preferred.
• 2+ years of customer service experience in member services, health care, or in a customer service or call center environment required.
• 1+ years of experience directly interpreting and explaining medical, dental, and/or vision plan benefits to both plan members and healthcare providers required.
• A strong understanding of benefit interpretation, including coverage and eligibility, member cost-share, plan limitations/exclusions, and prior authorization requirements.
• Ability to work remotely with a private, distraction-free workspace and a reliable high-speed internet connection suitable for handling confidential member information and phone-based work.
• A team-first mindset with a high level of motivation and drive.
• Naturally compassionate with an ability to navigate sensitive and challenging situations with care, patience, and professionalism.
• A passion and proactive approach in contributing to organizational missions focused on improving member healthcare experiences.
• Persistent, detail-oriented, and committed to seeing tasks through to completion with a high degree of accuracy.