Member Benefits Advocate

The OccuNet Company

Member Benefits Advocate serving at the forefront of The OccuNet Company's healthcare approach. Providing exceptional support and navigating members through healthcare plans.

Posted 7/22/2026full-timeAmarillo • Colorado, Nevada, New Mexico, Oklahoma, Texas • 🇺🇸 United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in member services, including benefit interpretation and eligibility verification, while upholding compliance with HIPAA standards. Exhibits strong communication skills in both English and Spanish to effectively support members and providers in navigating healthcare plans.

Highest-signal resume keywords

Customer Service ExperienceBenefit InterpretationBilingual Fluency in English and SpanishHIPAA ComplianceCompassionate Communication

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Benefit InterpretationEligibility VerificationPlan Document ExplanationClaim Status InquiryReference-Based Pricing (RBP) Knowledge

Soft Skills

Compassionate SupportDetail OrientedTeam-First MindsetMotivation and DriveProfessionalism

Industry Keywords

Healthcare PlansMember ServicesCustomer ServiceCall Center EnvironmentPrior Authorization Requirements

About the role

Key responsibilities & impact

Serve at the forefront of The OccuNet Company’s experience-centric approach.
Provide members with exceptional support by delivering high-quality, professional, and efficient service across multiple channels.
Liaise with members and providers to resolve inquiries and assist in the navigation of Reference-Based Pricing (RBP) health plans.
Uphold best-in-class member experiences by owning the end-to-end resolution process.
Practice TOC’s “outward mindset” philosophy through providing empathic support to members.
Service members as they navigate their employer-sponsored healthcare plans by quoting benefits, interpreting plan documents, and answering questions regarding claim status.
Service providers by providing eligibility verification and answering questions regarding claim status and pricing inquiries.
Work across cross-functional teams to establish processes that relieve challenges members are facing.
Uphold compliance and confidentiality standards relating to HIPAA when corresponding with members or providers.

Requirements

What you’ll need

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.
Strong understanding of benefit interpretation, including coverage and eligibility, member cost-share, plan limitations/exclusions, and prior authorization requirements.
For remote candidates, ability to maintain a private, distraction-free workspace with a reliable high-speed internet connection suitable for handling confidential member information and phone-based work.
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.
Passionate and proactive 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.