Member Care Advocate (MCA) - Bilingual

Responsibilities

Provide Member-Centered Support in a High-Volume Environment: Answer inbound calls from English and Spanish-speaking members respectfully and empathetically, using clear, plain language to help members feel confident and informed.
Resolve Core Member Issues: Address a broad range of member needs, including:
Explaining benefits coverage, cost-sharing concepts (deductibles, copays, coinsurance, and out-of-pocket maximums), and basic eligibility details in member's preferred language.
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

• Bilingual proficiency; full fluency in both English and Spanish is required.
• 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.