Member Services Advocate
About The Position
Member Services Advocates play a critical role in delivering advanced advocacy services, serving as a trusted resource for members navigating complex healthcare and employer benefit situations. This role is intended for experienced professionals with a strong background in health insurance, claims resolution, or benefits administration who can independently assess issues, interpret plan details, and drive outcomes across multiple stakeholders. In this role, you will guide individuals through complex coverage scenarios, resolve escalated claims and billing issues, and partner directly with providers, carriers, and third-party administrators to ensure accurate and timely resolution. This position requires a high degree of ownership, critical thinking, and the ability to manage sensitive or multi-layered issues with minimal oversight. We are seeking candidates who bring proven, hands-on experience navigating health plans and claims processes, including direct interaction with providers or carriers. Successful candidates will be confident advocating on behalf of members in complex situations and comfortable managing issues that require coordination across multiple parties. This role is best suited for individuals with experience in health insurance, TPAs, provider offices, or benefits administration who are ready to apply their expertise in a highly specialized, member-facing advocacy role.
Requirements
- Strong background in health insurance, claims resolution, or benefits administration
- Proven, hands-on experience navigating health plans and claims processes
- Direct interaction with providers or carriers
- Experience in health insurance, TPAs, provider offices, or benefits administration
- High degree of ownership
- Critical thinking skills
Responsibilities
- Guide individuals through complex coverage scenarios
- Resolve escalated claims and billing issues
- Partner directly with providers, carriers, and third-party administrators to ensure accurate and timely resolution
- Independently assess issues
- Interpret plan details
- Drive outcomes across multiple stakeholders
- Manage sensitive or multi-layered issues with minimal oversight
- Advocate on behalf of members in complex situations
- Manage issues that require coordination across multiple parties
Benefits
- Medical, Dental, Vision Insurance
- Flex Spending or HSA
- 401(k) with company match
- Profit-Sharing/Defined Contribution (1-year waiting period)
- PTO/Paid Holidays
- Company-paid ST and LT Disability
- Maternity Leave/Parental Leave
- Subsidized Parking
- Company-paid Term Life/Accidental Death Insurance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
