Care Advocate

• Prioritize tasks and manage a schedule of high-volume introductory video appointments with members
• Promptly answer member questions, assist with product-related needs, and provide personalized recommendations
• Deliver an exceptional member experience and appropriately escalate concerns or questions
• Navigate members’ healthcare networks to ensure access to care and investigate available resources and support
• Coordinate with team members to facilitate timely access to care, provide follow-up, and close the loop with members
• Provide education and resources related to members’ program needs
• Collaborate with cross-functional partners across Care Delivery, Customer Support, Provider, and Product teams
• Execute tasks supporting an optimal member experience and take ownership of outstanding items
• Participate in cross-functional projects and collaborate with other departments
• Identify referral needs and collaborate with Maven providers
• Anticipate and address members’ social determinants of health needs

Care Advocate helping US members navigate Maven’s virtual women’s and family healthcare platform

Care Advocate helping US members navigate Maven’s virtual women’s and family healthcare platform.
Providing education, referrals, and care coordination across Maven’s digital health programs.

• Process incoming calls, faxes, and voicemails from claimants, providers, clients, attorneys, and others
• Resolve claims-related questions and issues according to guidelines and policies
• Communicate claim status and current claim activity with clients and appropriate medical contacts
• Respond to jurisdiction- and claim-specific inquiries
• Enter data into claims systems
• Ensure claim files are properly documented and claims coding is correct
• Coordinate claimant address updates or changes with internal departments
• Provide referrals to legal, utilization review, pharmacy, and Special Investigations Unit teams
• Coordinate independent medical examinations
• Support the organization’s quality programs
• Perform other duties as assigned

Consumer Care Advocate handling claims inquiries for Sedgwick’s risk and claims administration services

Consumer Care Advocate

Consumer Care Advocate handling claims inquiries for Sedgwick, a global risk and claims administration partner. Processing customer communications, documenting claims, and coordinating referrals and medical examinations.

• Provide administrative and workflow support across Claims Operations, Subrogation, Litigation Technical Services, and Nurse Case Management
• Serve as a primary contact for internal and external inquiries via phone, email, fax, chat, and web portals
• Manage and process requests for claim-related documentation
• Index, process, and maintain claim files for efficient review and regulatory compliance
• Support claim intake by gathering information, identifying initial compensability considerations, and documenting claims
• Coordinate and process time-sensitive external requests, including workers’ compensation forms, OSHA reports, police reports, conservation records, death certificates, and driver’s license suspensions
• Prepare and distribute claim files to attorneys, subrogation adjusters, and other partners
• Manage ClaimCenter queues and ImageRight for document handling and task completion
• Coordinate IME scheduling, follow-up appointments, transportation, and hotel reservations
• Partner with external vendors including CorVel, OneCall, Metro Reporting, and HomeLink
• Manage certified mailings and collections activities, including monthly expense reconciliation
• Promote MEM Insurance services to policyholders, producers, medical providers, injured workers, and attorneys when appropriate
• Act in accordance with MEM Insurance’s vision, mission, and values

Claims Care Advocate supporting workers’ compensation claims administration at MEM Insurance

Claims Care Advocate

Claims Care Advocate supporting administrative workflows and customer inquiries for MEM Insurance’s workers’ compensation claims operations. Managing claim files, documentation, intake, vendor coordination, and scheduling.

• Own the member relationship by educating members about Progyny and their personalized benefits
• Onboard new members by capturing demographic information, confirming eligibility, and providing detailed benefit guidance
• Deliver concierge-level support through phone, email, and secure messaging
• Respond to member inquiries with empathy and accuracy
• Partner with internal teams to resolve complex inquiries, escalations, and member issues
• Liaise between members and fertility clinics, including appointment scheduling and care coordination
• Maintain accurate documentation while managing member cases
• Participate in ongoing learning and development and contribute to continuous improvement

Progyny Care Advocate supporting U.S. members through fertility and women’s health journeys

Progyny Care Advocate supporting U.S. members through fertility, family-building, and women’s health benefits.
Delivering concierge service, onboarding, benefit guidance, care coordination, and issue resolution across multiple channels.

• Serve as the first point of contact for new referrals, families, caregivers, and case managers, and as a consistent relationship throughout the care journey
• Explain the purpose and services of Here Now Health in a way that reduces fear and confusion and builds confidence in care
• Guide patients and families through admissions and onboarding, making sure they understand each step required to begin care
• Act as a supportive liaison among caregivers, biological parents, case managers, and child welfare staff
• Verify Medicaid eligibility, plan ID numbers, and benefits for prospective and existing patients
• Monitor insurance status over time and proactively assist patients whose coverage has lapsed or changed
• Schedule, reschedule, and rebook appointments as needed
• Conduct proactive, high-touch outreach to patients and families who have missed appointments or disengaged from care
• Help patients and caregivers access telehealth appointments and navigate the technology required to participate
• Assist patients in completing required documentation and onboarding materials
• Collaborate closely with providers, clinical teams, and other operational teams to support patient access and continuity of care

Care Advocate coordinating support for children and families in mental health.

Care Advocate – Spanish Fluency Required

Care Advocate coordinating support for children and families impacted by the child welfare system. Responsible for admissions, scheduling, benefits verification, and patient engagement activities in a remote role.

• Provide comprehensive administrative and workflow support across Claims Operations, Subrogation, Litigation Technical Services, and Nurse Case Management.
• Serve as a primary point of contact for internal and external inquiries, delivering timely, accurate, and professional responses via phone, email, fax, chat, and web portals.
• Manage and process requests for claim-related documentation, including wage statements, earnings affidavits, medical records, offer letters, rating requests, and records requests through third-party vendors.
• Index, process, and maintain claim files to ensure all required information is accurately captured for efficient claims review and regulatory compliance.
• Support claim intake activities by gathering necessary information, identifying initial compensability considerations, and documenting claims in accordance with established procedures.
• Coordinate and process time-sensitive external requests, including Division of Workers’ Compensation forms, OSHA reports, police reports, conservation records, death certificates, and driver’s license suspensions.
• Prepare and distribute claim files to attorneys, subrogation adjusters, and other partners as needed.
• Manage activities within ClaimCenter queues and ImageRight to ensure timely document handling and task completion.
• Coordinate logistics for injured workers and claims staff, including IME scheduling, follow-up appointments, transportation arrangements, and hotel reservations.
• Partner with external vendors such as CorVel, OneCall, Metro Reporting, and HomeLink to support claims operations.
• Manage certified mailings and collections-related activities, including monthly expense reconciliation.
• Promote MEM Insurance services to policyholders, producers, medical providers, injured workers, and attorneys when appropriate.
• Act in accordance with MEM Insurance’s vision, mission, and values in all interactions and work activities.

Claims Care Advocate providing support in MEM Insurance’s Claims Department

Claims Care Advocate I

Claims Care Advocate providing administrative and workflow support in MEM Insurance’s Claims Department. Managing inquiries and documentation to ensure smooth claims processes.

• Serve as the primary point of contact for patients after their intake visit.
• Help patients understand and act on their care plan — scheduling appointments, finding in-network providers, and using their Medicare benefits.
• Resolve navigation friction: portals, referrals, appointment logistics, forms, and provider communications.
• Identify practical and social-needs support (food, housing, transportation, etc.) and connect patients to available resources.
• Coordinate with clinical team members involved in a patient's care, while providing non-clinical support only.
• Document every patient interaction and support activity in our platform, accurately and on time.
• Maintain confidentiality and comply with HIPAA, privacy, and all applicable platform standards.

Care Advocate supporting Medicare patients navigating healthcare services.

Certified Nursing Assistant, Care Advocate – Patient Navigation

Care Advocate providing non-clinical navigation support to Medicare patients. Helping them understand care plans and access community resources after clinical visits.

Care Advocate helping Medicare patients navigate healthcare systems effectively

Licensed Practical Nurse – Care Advocate, Patient Navigation

Care Advocate supporting Medicare patients in understanding care plans and connecting to resources. Managing patient interactions while ensuring HIPAA compliance in a remote setup.

• Execute person-centered care plans for patients with serious, high-risk illnesses. Assist in monitoring and revising disease-specific plans, especially when frequent adjustments in medication or treatment regimens are required.
• Act as the link between the patient and the billing practitioner. Support care coordination by managing provider availability, rescheduling, and providing post-hospital discharge support.
• Conduct person-centered assessments to understand the patient’s social and cultural context. Identify unmet social needs—such as food insecurity or housing instability—that impact the management of their serious condition and develop specific action plans to address them.
• Assist patients and caregivers in navigating the New Jersey healthcare landscape. Teach self-advocacy skills to help patients communicate effectively with specialists and coordinate transportation or access to telehealth.
• Support patient communication templates and automation. Coordinate with the tech team to set up workflows, handle technical troubleshooting, and update patient charts in the Case Management System (CMS) with precision.
• Refer patients to supportive services and community-based resources. Establish and maintain partnerships with local New Jersey organizations to bring targeted resources (legal aid, food assistance, etc.) to our members' attention.
• Use motivational interviewing and capacity-building to help patients manage the stress of chronic illness. Provide tailored education to improve treatment adherence and offer emotional support to families and caregivers.
• Maintain detailed logs of all interactions, including the amount of time spent and specific activities performed. Ensure all documentation meets the standards required for Medicare clinical and social integration services.

Care Advocate supporting community healthcare program at Wider Circle

Care Advocate – Care Delivery

Care Advocate supporting Wider Circle's Care Delivery program. Focused on bridging clinical and social needs for patients in community healthcare.

Care Advocate supporting health plan members in community care programs

Care Advocate, Care Delivery

Care Advocate supporting health plan members through person-centered care and community health navigation. Working closely with clinicians to bridge clinical and social needs for high-risk patients.

• Screen Patients and Manage Intake You will call patients and ask health-related questions using a set script. These calls usually last 15 to 20 minutes. Your goal is to make patients feel comfortable so they share honest answers.
• Connect Patients to Resources You will ask questions to learn what each patient needs. Then you will share resources and send referrals to health and mental health services.
• Keep Accurate Records During each call, you will type patient responses into a health records system called an Electronic Health Record (EHR). You will review and finalize your notes before the end of each workday. All records must follow federal privacy rules (HIPAA) and billing standards. You will also collect and record patient consent at the start of each call.
• Manage Your Schedule You will keep your own daily calendar, send reminder calls to reduce missed appointments, and meet weekly goals. You will also schedule follow-up calls for patients and leave time between appointments to finish your notes.

Associate Care Advocate providing support to patients in their health journeys

Associate Care Advocate – Care Delivery

Associate Care Advocate supporting patients by connecting them to health services and resources. Involved in managing calls and maintaining accurate patient records for improved health equity.

• 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.

Member Care Advocate providing healthcare navigation and support to members remotely

Member Care Advocate, MCA

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

• Provide a high degree of customer service and professionalism when interacting with the patients of providers via the phone or email; ability to empathize and diffuse difficult situations professionally and in a caring manner
• Assist members with detailed provider searches utilizing network look-up tools
• Assist members navigating our digital programs and serve as a conduit for escalations and questions
• Contact provider offices or facilities to obtain needed prior authorization pieces such as additional medical records, forms, facility location or Tax ID numbers for claims billing
• Assist with claims work such as adjusting site of service
• Protect/observe patient privacy and confidentiality, per external regulatory requirements (HIPAA) and internal policy and procedures
• Ensures compliance with applicable URAC and NCQA accreditation guidelines and state and federal regulations

Care Guide Advocate supporting RN Care Coordinators at Evry Health.

Care Guide Advocate

Care Guide Advocate assisting patients and providers in navigating health services at Evry Health. This fully remote position upholds patient confidentiality while providing essential member support.

Care Advocate jobs in United States

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Care Advocate

Consumer Care Advocate

Claims Care Advocate

Care Advocate

Care Advocate – Spanish Fluency Required

Claims Care Advocate I

Certified Nursing Assistant, Care Advocate – Patient Navigation

Licensed Practical Nurse – Care Advocate, Patient Navigation

Care Advocate – Care Delivery

Care Advocate, Care Delivery

Associate Care Advocate – Care Delivery

Member Care Advocate, MCA

Care Guide Advocate