Member Advocate

Allied Benefit Systems•Chicago, IL

3d•$20 - $22•Remote

About The Position

The BPO Member Advocate supports health plan members by providing high quality customer service related to benefit education, provider access, and claim related inquiries, including balance billing resolution and provider search support. This role serves as a liaison between members, providers, and internal teams to ensure timely, accurate, and effective resolution of member needs. The Member Advocate manages inbound and outbound communications, gathers information and documents, explains plan details and next steps, and escalates issues as needed to support a positive member experience and successful outcomes.

Requirements

High school diploma or equivalent required.
1 to 2 years of Customer Service experience required
Excellent verbal and written communication skills.
Excellent interpersonal and customer service skills.
Proficient with Microsoft Office Suite or related software.
Excellent time management skills with a proven ability to meet deadlines.
Strong analytical and problem solving skills.
Ability to function well in a high paced and at times stressful environment.

Nice To Haves

1 to 2 years’ experience in employee health and benefit plan administration preferred

Responsibilities

Respond to inbound member inquiries via telephone and email, addressing questions related to provider access, plan benefits, claims, and balance billing concerns.
Conduct outbound outreach to providers to confirm plan acceptance, gather required information, support balance billing resolution, and facilitate access to care for members.
Educate members, providers, employers, brokers, and internal partners on plan design, coverage, and available tools and resources to support informed decision making.
Obtain, review, and document all relevant information necessary to assess provider access issues and balance billing concerns, including coordinating signed HIPAA authorizations when required.
Serve as a communication liaison between members, providers, and internal teams to ensure timely updates, clarity on next steps, and resolution progress.
Accurately document all interactions and activities in applicable systems, maintaining detailed records of inquiries, actions taken, and outcomes.
Meet and sustain productivity, quality, and customer service performance metrics established by management.
Demonstrate a strong understanding of workflows, business processes, and service strategies across BPO Reference Based and related products.
Foster urgency and accountability in resolving member issues and achieving service goals.
Collaborate with Client Service team members and leadership on assigned projects, ad hoc reporting, and process support.
Escalate complex access or resolution issues to leadership as appropriate to support service commitments and success measures.
Other duties as assigned.