Advocate

• Make inbound and outbound calls to members and providers regarding healthcare visits, screenings, vaccinations, and medication refills
• Work through barriers affecting members’ health
• Deliver a professional and empathetic member experience
• Educate members to support healthy decisions and improve health outcomes
• Explain benefits for specific screenings and medications
• Assist members with health services, medications, and resources to improve Star health outcomes
• Accurately document conversations in members’ health records
• Answer questions, resolve issues, and escalate issues when needed
• Meet business metrics and goals while working efficiently in a fast-paced environment

CVS Health advocate guiding Medicare members through screenings, medications, and health services remotely

Health Advocate – Inbound/Outbound Calls, Healthy Outcomes Team

CVS Health Health Advocate educating Medicare members about screenings, medications, and benefits through inbound and outbound calls. Documenting interactions and addressing barriers remotely from Georgia.

• Make inbound and outbound calls to members and providers to help obtain healthcare visits, screenings, vaccinations, and medication refills
• Work through barriers that stand in the way of members’ good health
• Deliver the best member experience through professional, empathetic conversations
• Educate members to help them make healthy decisions
• Accurately document conversations in members’ health records
• Explain benefits for specific screenings and medications
• Assist members with important health services, medications, and resources to improve Star health outcomes
• Escalate issues for resolution when needed

CVS Health Advocate guiding Pennsylvania Medicare members through screenings and medications remotely

Health Advocate – Inbound/Outbound Calls

CVS Health Advocate guiding Pennsylvania Medicare members through screenings, vaccinations, medications, and benefits. Conducting high-volume calls and documenting member health records remotely.

• Act as an advocate for members and liaison between the Health Plan and providers to ensure availability and access to care
• Establish a community presence and promote member education
• Identify and resolve systemic barriers limiting access to appropriate care
• Receive and respond to member complaints and formal grievances
• Serve as primary contact and liaison between member advocacy groups, human services agencies, providers and State entities
• Evaluate member qualifications for better benefit entitlement programs
• Conduct field trainings and face-to-face meetings with providers, members and community agencies
• Report results to senior management and recommend needed resolutions
• Recommend internal process changes to improve provider and member satisfaction
• Advise the Health Plan on contract compliance in delivery of covered services
• Perform training, orientation and coaching for performance improvement
• Educate members and providers on benefits-related policies and procedures, website promotion and education
• Investigate and resolve access and cultural sensitivity issues
• Participate in local community coalitions
• Update and revise educational materials as appropriate
• Perform other duties as assigned
• Comply with all policies and standards

Member Advocate II improving healthcare access for Centene health-plan members

Member Advocate II

Member Advocate II improving healthcare access for Centene’s health-plan members. Resolving grievances, coordinating providers and agencies, and conducting community-based education and training.

• Make inbound and outbound calls to members and providers to schedule healthcare visits, screenings, vaccinations, and medication refills
• Work through barriers that prevent members from achieving good health
• Deliver a professional and empathetic member experience
• Educate members to support informed health decisions and improve health outcomes
• Explain benefits related to screenings, medications, activities, and follow-up care
• Assist members with appointments, medication refills, and health-service resources
• Accurately document conversations in members’ health records
• Answer questions, resolve issues, and escalate issues when needed
• Meet business metrics and performance goals
• Complete four weeks of virtual training, potentially on a different shift temporarily

CVS Health Health Advocate guiding Medicaid members through screenings, medications, and follow-up care

CVS Health Health Advocate contacting Medicaid members and providers about screenings, medications, appointments, and follow-up care. Documenting health interactions and improving member outcomes remotely.

• Answer inbound calls from members and providers regarding claims, contracting, and provider relations
• Handle a high volume of calls in a structured phone queue environment
• Make outbound calls for issue resolution and follow-up
• Use multiple applications during calls to research and resolve inquiries
• Address claim status inquiries and explanations
• Process requests for claim reprocessing or adjustments
• Handle provider contract questions and demographic updates
• Correct authorizations to ensure proper claim payment
• Process requests for duplicate EOBs or check reissuance
• Handle escalated issues through Advocate Handoff/Help Request (AHHR)
• Submit complaints on behalf of members or providers
• Email resources and documentation to callers

Claims and provider relations advocate resolving behavioral health inquiries for Evernorth

Provider Relations & Claims Advocate

Claims and provider relations advocate handling inbound behavioral health calls for Evernorth Health Services. Resolving claims, authorizations, contracts, complaints, and payment issues.

• Handle a portfolio of Property & Casualty claims across General Liability, Property, and Auto lines from initial notice through resolution
• Review carrier coverage positions, reservation-of-rights letters, and disclaimers; draft policy-based rebuttals and appeals
• Monitor claims activity, maintain diary entries in Epic, and follow up on open matters
• Identify potential E&O exposure and escalate matters according to internal protocols
• Coordinate with carrier adjusters, defense counsel, and third-party administrators
• Serve as day-to-day claims contact for assigned clients
• Build relationships with carrier claim adjusters, supervisors, and partner contacts
• Participate in PRISM calls, quarterly claim reviews, and renewal strategy meetings
• Support Special Handling Instructions for self-insured/captive accounts
• Collaborate with Account Executives, producers, and internal departments
• Engage across specialty lines, healthcare, and professional/executive risk practice groups
• Update claims dashboards, successful results logs, and management reporting tools
• Participate in internal training and share knowledge with team members
• Mentor junior claims advocates and analysts on coverage questions and claim-handling practices
• Support operational initiatives, claims review standardization, and Smartsheet workflows
• Assist with claim file audits and pursue continuing education and designations

Senior claims advocate handling P&C coverage disputes for HUB International insurance clients

Senior Claims Advocate – Property & Casualty Claims

Senior claims advocate handling Property & Casualty coverage disputes for HUB International, a full-service insurance brokerage. Managing client claims, carrier negotiations, appeals, and cross-functional claims strategy.

• Communicate with insureds, carriers, adjusters, and attorneys/counsel throughout the life of a claim
• Review and evaluate insurance policies to determine where coverage potentially exists
• Evaluate legal documents, including complaints, leases, and contracts, to determine proper claim handling, liability, and insurable interest
• Advocate first-party property claims from initial claim report through settlement on behalf of HUB clients
• Organize and participate in claim review meetings and new business presentations
• Maintain file diaries for follow-up and document all follow-ups within claim files
• Interact with account service teams
• Create and issue correspondence, including written advocacy on behalf of HUB clients
• Track claim success stories
• Contribute to quarterly newsletters and articles based on claim scenarios
• Demonstrate effective team management skills

Senior Claims Advocate managing first-party property claims for HUB International, a commercial insurance broker

Senior Claims Advocate

Senior Claims Advocate managing first-party property claims for HUB International, a leading commercial insurance broker. Reviewing coverage, liability, legal documents, and settlements while advocating for clients.

• Answer members’ questions through inbound calls and outbound calls
• Manage and support a specific group of members
• Ensure member issues, questions, and concerns are resolved across SCAN’s internal and external value chain
• Drive SCAN’s Concierge customer service philosophy
• Assist team leads, Concierge, and Associate Concierge staff in managing membership books of business
• Resolve member questions primarily through an inbound call queue
• Follow up on pending member issues
• Research issues to determine resolutions
• Conduct proactive outreach to members
• Perform hand-offs among team members
• Coordinate issue resolution with internal and external stakeholders
• Maintain relationships with stakeholders and provide feedback on processes, content, issues, and trends
• Document member interactions and update records
• Participate in team huddles about member issues, trends, and resolutions
• Participate in member calling projects supporting membership retention
• Follow applicable Federal and State regulatory requirements, company policies, and HIPAA requirements
• Support SCAN’s vision and goals
• Perform other duties as assigned

Concierge Advocate resolving healthcare member issues for SCAN, a nonprofit senior-care health organization

Concierge Advocate

Concierge Advocate resolving healthcare member issues for SCAN, a nonprofit health organization serving older adults. Handling high-volume calls, research, outreach, documentation, and stakeholder coordination.

• Coordinate cancer screening appointments with external healthcare facilities.
• Call facilities to collect availability and book appointments according to patient facility and scheduling preferences.
• Assist patients in understanding out-of-pocket costs.
• Update the facilities database with accurate and reliable information.
• Identify suitable facilities based on insurance, location, and patient preference.
• Confirm facilities can perform procedures, are in network, and can accommodate patients.
• Obtain appointment and referral results from facilities via fax and phone.
• Review and triage the inbound fax queue and upload documents and results appropriately.
• Inform patients promptly about scheduled appointments, locations, and preparation instructions.
• Respond to patient inquiries and support tickets.
• Accurately document appointment, order, and referral details in Color’s EHR system.
• Address scheduling conflicts, rescheduling needs, and access issues.
• Collaborate with clinical and administrative teams to support seamless patient care.

Cancer screening advocate coordinating U.S. patient appointments for Color’s virtual cancer clinic

Cancer Screening Advocate – Temporary Contractor

Cancer Screening Advocate coordinating U.S. patient screenings for Color’s virtual cancer clinic.
Scheduling appointments, retrieving results, supporting patients, and documenting care in EHR systems.

• Act as a flexible resource to cover the most critical parts of the business, completing in-home and virtual visits by being available when assigned team members are out of office or unavailable
• Independently capture vitals using connected devices and digital tools, track changes in condition, observe the home environment, and communicate early warning signs to the care team
• Identify, document, and aggressively follow up on critical social needs (e.g., food insecurity, housing instability, transportation issues, safety concerns) to ensure continuity in resource navigation and benefits assistance
• Support essential care coordination needs, including patient accountability with medication changes, follow-up on referrals, appointment scheduling, testing, and home health services
• Set up, support, virtually troubleshoot, and conduct virtual visits with primary care or behavioral health clinicians, confidently navigating video platforms and connected devices to ensure smooth technology use for both patients and clinicians
• Review and quickly understand patient care plans—often with the help of our digital and AI-assisted tools—to effectively coach patients and hold them accountable to self-management goals during coverage periods
• Maintain highly accurate EHR documentation, leveraging available digital and AI-supported workflows to ensure seamless handoffs and consistent updates back to the primary care team after float coverage

Health Advocate providing continuity of care for patients with complex needs.

Community Health Advocate

Health Advocate ensuring continuity of care for patients with complex needs at Accompany Health. Supporting in-home and virtual visits, capturing vitals, and managing social needs.

• Initiates engagement with assigned members to introduce the program and gather updated member demographic information with speed, accuracy, and a positive attitude.
• Schedules completion of the assessment based on the member’s preferences and the assigned care manager’s schedule.
• Accurately and consistently documents each call in the member’s electronic record, thoroughly completing required actions with a high level of detail to ensure we meet our compliance requirements.
• Protects the confidentiality of member information and adheres to company policies regarding privacy/ HIPAA
• Effectively supports members during enrollment calls, appropriately managing difficult or emotional member situations, responding promptly to member needs, and demonstrating empathy and a sense of urgency when appropriate.
• Conducts triage, connecting members with appropriate care team personnel including care managers and customer service when needed.
• Ability to be agile, manage multiple priorities, and adapt to change with enthusiasm.
• Demonstrates an outgoing, enthusiastic, and caring presence over the telephone.
• Act as a Medicaid recertification specialist for the team.

Member Advocate engaging with DSNP members in New Jersey

Member Advocate – Field

Member Advocate engaging DSNP members in New Jersey through outreach and support. Accountability for compliance and empathy during member enrollment calls with travel requirements.

• Reviews appeal requests from members and providers in accordance with BCBSF policies and procedures, regulatory guidelines, and timelines. (15%)
• Resolves grievances, appeals or disputes involving expressions of dissatisfaction, reimbursement, medical necessity, ClaimCheck®, Utilization Management, and Fee for Service payments within regulatory timeframes for all lines of business except SAO & FEP. (15%)
• Researches and resolves provider data loads. (5%)
• Locates medical records and form CMS-1500 on Enterprise Imaging or Imaginator for clinical review or to verify proper coding (modifiers and procedure codes). (10%)
• Accesses various web-based and other applications to review how claim was originally paid by BCBSF. (5%)
• Researches and documents all issues and findings. (5%)
• Enters appeal or dispute determinations into various BCBSF systems and SQL databases. (5%)
• Follows regulatory requirements as appropriate and corporate values, policies and procedures. (15%)
• Ensures final determination with statement that supports determination is communicated to provider within required timelines. (5%)
• Completes customized correspondence with appropriate statement that supports final determination. (5%)
• Follows strict timelines for communicating final determination. (5%)
• Documents final disposition of dispute into BCBSF systems and SQL databases (5%)
• Facilitates escalated calls and issues from providers and members regarding appeals or dispute decisions. (5%)

Service Advocate V handling appeals and disputes for Florida Blue

Service Advocate V – Appeals, Disputes

Service Advocate V handling appeals and disputes at Florida Blue. Review requests and resolve grievances following regulatory guidelines.

• Acts as an advocate and claims specialist to provide support to clients, claimants, Producers, and carriers;
• Provides initial and on-going advocacy on claims including detailed analysis, interpretation, consultation and negotiation of coverage and reserves;
• Provides assistance on complex, large claims issues;
• Reports to carriers on property, liability, litigated, high exposure and specialty claims;
• Maintains claim diaries and reviews reservations of rights of denials;
• Travels to loss sites to assist clients with the claim process;
• Meets with clients and internal staff to provide analysis, interpretation and recommendations regarding client loss information;
• Responds to clients and Producers regarding coverage, exposure, and settlement questions;
• Manages subrogation and recovery situations by working closely with client;
• Prepares coverage arguments for client advocacy and form coverage positions as client advocate;
• Works with client legal counsel on coverage, claims and strategy for settlement;
• Assists client with case preparation and support as needed, using negotiation skills to provide best possible outcome for clients;
• Provides value added services to Producers, focusing on account retention and obtaining new business;
• Develops training materials with a client and service team perspective for coverage reviews, loss reporting procedures, and claims guidelines in handling various situations;
• Conducts quarterly claims review meetings with employer representatives;
• Complies with agency management system data standards and data integrity (enters and maintains complete and accurate information);
• Other duties as assigned.

Claims Advocate providing support to clients in the United States

Claims Advocate

Claims Advocate specialized in providing support to clients and handling complex claims for insurance carriers in the United States. Demonstrates expertise in problem-solving, analysis, and negotiation across various claims.

• Provides outstanding support to inbound callers regarding Health Spending Account, COBRA, Retiree or Exchange inquiries and requests.
• Assists with enrollment related to Health Spending Account, COBRA, Retiree or Exchange programs
• Answer inbound calls professionally, with high energy and a positive attitude and a little charm.
• Respond accurately and thoroughly to caller inquiries and document call details accordingly.
• Ensure compliance in all areas of processing, completing all transactions timely and accurately.
• Take accountability for the entire process from receipt of work to resolution.
• The ability to jump in and help. This is a “roll up your sleeves” position, and you will need to understand our business, our client’s business, and processes so you can help others effectively do their jobs.
• Work under general supervision following established procedures.

Senior Member Advocate supporting clients with Health Spending Account inquiries

Senior Member Services Advocate

Senior Member Advocate providing support for Health Spending Account inquiries via phone. Fostering relationships with clients through responsive service and assistance in enrollment processes.

• Identify and pursue safe alternatives to hotel stays whenever possible.
• Provide advocacy, crisis counseling, and access to crisis services and housing programs to callers on our crisis line.
• Support the crisis services team in navigating safe shelter options and diversion strategies for survivors of violence.
• Provide victim advocacy, crisis counseling and education to survivors of violence staying at Friends House.
• Comply with data tracking and documentation requirements.
• Works remote and provides virtual support.

Crisis Line Advocate providing support and advocacy for survivors of violence

Crisis Line Advocate

Crisis Line Advocate supporting survivors of violence through advocacy and crisis counseling. Working in a hybrid model from Waterloo, Iowa with a focus on safe shelter options.

• Assists clients in reporting claims to carriers, advise on managing emergency services and how to begin documenting the claim
• Consider and advise client on any other resources such as restoration firms, engineering consultants or claim preparation services
• Assist clients with managing cash flow by advocating for early advance payments and ongoing partial payments as desired by the client
• Anticipate potential issues and communicate to the client and the adjustment team
• Provide advice and guidance on carrier coverage positions
• Advocate for client in response to any adverse coverage position
• Manage client claims to bring about timely and fair settlement by appropriate follow up activities and settlement negotiations
• Provide input to Risk Solutions placement team on client claims status as requested
• Provide feedback to the placement team on any identified coverage issues or concerns
• Develop Service Plans for claims handling based on client needs
• Support and strengthen the Practice through individual contributions and suggestions, mentoring and coaching of junior team members
• Provide assistance and support for new business development/RFPs
• Develop and maintain relationships with clients, independent adjusters and vendors for the benefit of our clients
• Keep current on marketplace changes
• Attend required training sessions, courses, etc. to develop and maintain up-to-date skills and maintenance of your broker’s license
• Maintain appropriate level of confidentiality of information processed
• Follow all company policies and procedures
• Other duties as assigned

Claims Advocate providing risk services for Property & Energy clients

Property & Energy Claims Advocate

Claims Advocate providing property and energy claims advocacy at Brown & Brown’s Risk Solutions team. Assisting clients in reporting claims, managing cash flow, and delivering timely settlement solutions.

• Provide accurate and easy-to-understand guidance in the complex world of health insurance and employer benefits across multiple channels (phone, text, chat, and email).
• Help new customers with their onboarding, making sure members understand and select appropriate health plans and other steps.
• Assist members with issues around their care journey - whether it’s finding a provider, helping with claims issues, or referring them to expert clinical care managers.
• Give feedback to the product team about member support issues so they can design better experiences.
• Generally strive to make sure members feel taken care of and love our service.

Member Advocate providing guidance in navigating health insurance for Sana

Member Advocate

Member Advocate at Sana providing health insurance guidance and supporting members’ needs. Join a remote-first company focused on making healthcare seamless.

• Remain available throughout agreed hours of coverage for contact by the RMI GCC
• Deploy to pre-defined medical facilities in area of operation to meet and greet RMI patient within 1 hour of notification from GCC (Or any other agreed timeframes).
• Work in conjunction with the GCC to ensure that payment methods have been agreed with the receiving medical facility.
• Where applicable, act as a mediator between medical facility and GCC.
• Ensure swift access to care for RMI patients, responding to problems in a pragmatic and professional manner to resolve as quickly as possible.
• Provide translation from local dialect to English in both verbal and written forms and pass this on to the GCC.
• Deploy to medical facilities daily when a protracted in-patient stay occurs.
• Manage the welfare of patients through any admission to a medical facility, ensuring that the patient is comfortable, understands the treatment being provided and meets reasonable requests for support.
• Establish working relationships with treating physicians and, where applicable, speak directly with the treating medical team to acquire up to date information.
• Provide timely updates to the GCC on the status and proposed plans for the patient in both written and verbal forms.
• Always demonstrate a professional and calm persona, with a confident ability to liaise with client management as required.
• Utilize local knowledge to arrange other services, as required.

Patient Advocate managing access to medical care for Remote Medical Inc.

Patient Advocate

Patient Advocate ensuring access to medical care for Remote Medical Inc. Responding to medical facility needs and providing patient support in Rhode Island.

• Provides and manages access to local medical care in the area of operation.
• Provides support to RMI Global Coordination Centre (GCC) in security and receipt of payments.
• Acts as the RMI representative for operational and pastoral requirements of patients.
• Remains available throughout agreed hours of coverage for contact by the RMI GCC.
• Deploys to pre-defined medical facilities to meet and greet RMI patients within 1 hour of notification.
• Works with the GCC to ensure payment methods are agreed with medical facilities.
• Acts as a mediator between medical facility and GCC where applicable.
• Ensures swift access to care for RMI patients and responds to problems pragmatically.
• Provides translation from local dialect to English.
• Manages the welfare of patients through admissions, ensuring comfort and understanding of treatment.
• Establishes working relationships with treating physicians and acquires updates on patient status.
• Provides timely updates to the GCC on the status and proposed plans for the patient.

Patient Advocate managing access to local medical care for Remote Medical Inc.

Patient Advocate managing access to local medical care for Remote Medical Inc. Providing operational support and advocacy for RMI patients, ensuring swift care access and support management.

• Provide and manage access to local medical care in the area of operation.
• Provide support to RMI Global Coordination Centre (GCC) in the security and receipt of payments to third party medical establishments.
• Act as the RMI representative for all operational and pastoral requirements of patients under the care of RMI.
• Remain available throughout agreed hours of coverage for contact by the RMI GCC.
• Deploy to pre-defined medical facilities in area of operation to meet and greet RMI patient within 1 hour of notification from GCC.
• Work in conjunction with the GCC to ensure that payment methods have been agreed with the receiving medical facility.
• Act as a mediator between medical facility and GCC where applicable.
• Ensure swift access to care for RMI patients, resolving problems in a pragmatic manner.
• Provide translation from local dialect to English in both verbal and written forms for GCC.
• Deploy to medical facilities daily when a protracted in-patient stay occurs.
• Manage the welfare of patients through any admission to a medical facility, ensuring comfort and understanding of the treatment.
• Establish working relationships with treating physicians for updates on patient status.
• Provide timely updates to the GCC on the status and proposed plans for the patient.
• Demonstrate a professional and calm persona while liaising with client management as required.
• Utilize local knowledge to arrange other services as required.

Patient Advocate providing access to medical care for Remote Medical Inc.

Patient Advocate managing access to medical care and patient support for Remote Medical Inc. Requires bilingual communication and handling operational tasks for medical facilities.

Advocate jobs in United States

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Health Advocate – Inbound/Outbound Calls, Healthy Outcomes Team

Health Advocate – Inbound/Outbound Calls

Member Advocate II

Health Advocate – Inbound/Outbound Calls

Provider Relations & Claims Advocate

Senior Claims Advocate – Property & Casualty Claims

Senior Claims Advocate

Concierge Advocate

Cancer Screening Advocate – Temporary Contractor

Community Health Advocate

Member Advocate – Field

Service Advocate V – Appeals, Disputes

Claims Advocate

Senior Member Services Advocate

Crisis Line Advocate

Property & Energy Claims Advocate

Member Advocate

Patient Advocate

Patient Advocate

Patient Advocate