Member Advocate

Job Description Description:The Member Advocate provides dedicated support to members and healthcare providers by responding to inquiries received by phone, fax, email, and mail to resolve balance billing issues and disputes. 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, efficient workflow, and directing issues to the appropriate resources to ensure timely and effective resolution.Requirements:Job Responsibilities:Provide exceptional customer service on all incoming and outgoing calls throughout the shift.Review and verify Balance Bills for accuracy and completeness.Conduct daily welcome calls to newly enrolled members and patients.Update all members/patients with open advocacy matters every 15 daysPrepare, file, and track correspondence related to disputeSupport members by answering questions related to the dispute and advocacy process.Document all interactions accurately and completely in the appropriate systems.Complete a minimum of 40–50 documented interactions per shiftRespond 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 mattersWork 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.Adhere to all HIPAA guidelines to ensure the confidentiality of member and patient information across calls and written communications Interpret plan documents/plan guidelinesRecommend process improvements that enhance member satisfaction and operational efficiency.Escalate advocacy concerns or complaints 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 member experiencesActive listening skills that support productive dialogue and effective issue resolutionExcellent written and verbal communication skillsStrong analytical and problem-solving abilities, including identifying issues and developing effective solutionsAbility to multi-task in fast-paced environmentHigh level of accuracy and attention to detailStrong organizational and time-management skills, with the ability to prioritize tasks efficientlyEducation and Experience:Minimum of 2 years of experience in the healthcare industry, preferably in patient advocacy, customer service, or claims processingAssociate degree or vocational/technical certification in a healthcare-related fieldDemonstrated experience using multi-line phone systems and electronic documentation softwareMedical billing and medical coding experience preferredBilingual proficiency is a plus