Member Advocate

The Member Advocate provides dedicated support to members and healthcare providers by resolving balance billing issues, managing appeals, and responding to inquiries received by phone, fax, email, and mail. Working independently within a clearly defined scope, the Advocate ensures every interaction is handled with accuracy, professionalism, and empathy. Key responsibilities include coordinating and prioritizing multiple time-sensitive tasks, maintaining an organized and efficient workflow, and directing issues to the appropriate resources to promote timely and effective resolution.

Job Responsibilities: 

•  Adhere to all HIPAA guidelines to ensure the confidentiality of member and patient information across calls and written communications Interpret plan documents/plan guidelines
•  Conduct daily welcome calls to newly enrolled members and patients.
•  Provide exceptional customer service on all incoming and outgoing calls throughout the shift.
•  Update all members/patients with open advocacy matters every 15 days
•  Review and verify Balance Bills for accuracy and completeness.
•  Prepare, file, and track correspondence related to dispute 
•  Document all interactions accurately and completely in the appropriate systems.
•  Complete a minimum of 40–50 documented interactions per shift
•  Support members by answering questions related to the dispute and advocacy process.
•  Respond to incoming correspondence (email, fax, mail, phone) within 24–48 hours.
•  Maintain consistent communication with facilities, providers, EBOs, and debt collectors to assist in resolving open advocacy matters
•  Work independently while effectively collaborating with team members.
•  Serve as a liaison with TPA partners, employer groups, and brokers to assist in resolving open advocacy matters.
•  Recommend process improvements that enhance member satisfaction and operational efficiency.
•  Escalate advocacy concerns or complains in accordance with established written guidelines.
•  Other duties as assigned.

Skills and Abilities: 

•  Exceptional customer service, with a focus on building rapport and delivering positive client experiences
•  Excellent written and verbal communication skills
•  Strong analytical and problem-solving abilities, including identifying issues and developing effective solutions
•  High level of accuracy and attention to detail
•  Active listening skills that support productive dialogue and effective issue resolution
•  Strong organizational and time-management skills, with the ability to prioritize tasks efficiently

Education and Experience: 

•  Minimum of 2 years of experience in the healthcare industry, preferably in patient advocacy, customer service, or claims processing
•  Associate degree or vocational/technical certification in a healthcare-related field
•  Demonstrated experience using multi-line phone systems and electronic documentation software
•  Medical billing and medical coding experience preferred Bilingual proficiency is a plus