Member Care Advocate, MCA

Included Health

Member Care Advocate supporting members' healthcare navigation via remote channels. Emphasizing empathetic and informed assistance in a high-volume environment.

Posted 7/2/2026contractRemote • 🇺🇸 United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong customer service skills in a high-volume environment, effectively communicating benefits and eligibility details while adhering to HIPAA guidelines. Proficient in using CRM software and navigating healthcare systems to resolve member issues and ensure continuity of care.

Highest-signal resume keywords

Customer Service SkillsVoIP Phone SystemsCRM SoftwareHIPAA ComplianceGoogle Workspace

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Benefits ExplanationCost-Sharing ConceptsEligibility DetailsIssue ResolutionDocumentation Skills

Soft Skills

EmpathyCritical ThinkingVerbal CommunicationWritten CommunicationDe-Escalation

Tools & Technologies

Included Health SystemsKnowledge BasesCarrier PortalsApple ProductsCXOne

Industry Keywords

Healthcare ExperienceMember AdvocacyHigh-Volume CallsRemote WorkMember Confidentiality

Tech Stack

Tools & technologies

VoIP

About the role

Key responsibilities & impact

Provide Member-Centered Support in a High-Volume Environment:
- Answer inbound calls and chats respectfully and empathetically, using clear, plain language to help members feel confident and informed.
Resolve Core Member Issues:
- Explaining benefits coverage, cost-sharing concepts (deductibles, copays, coinsurance, and out-of-pocket maximums), and basic eligibility details.
- 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.

Requirements

What you’ll need

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.*

Benefits

Comp & perks

Included Health is an Equal Opportunity Employer
3-week paid training period
Remote position requires a secure, distraction-free home office