Healthcare Support Advocate
Job Description:
- Handle inbound and outbound member and provider inquiries via phone, email, and chat
- Initiate member outreach regarding benefits
- Provide information on benefits, eligibility, coverage, claims, prior authorization, billing, reimbursement policies, and provider portal support
- Resolve inquiries, complaints, grievances, and escalations with complete documentation and proper routing
- Conduct follow-up outreach to ensure resolution, satisfaction, and continuity of care or claim outcomes
- Build trust through early, frequent, and personalized engagement
- Collaborate with Claims Operations, Network Operations, and Account Management teams on complex cases and service improvements
- Identify recurring issues, system gaps, and process inefficiencies and provide feedback to leadership
- Meet goals for efficiency, productivity, quality, accuracy, customer satisfaction, compliance, follow-up completion, and attendance
- Maintain confidentiality and compliance with HIPAA, ERISA, and XO Health policies
Requirements:
- 3–5 years of experience in a healthcare payer, TPA, or health insurance environment, including contact center/member-provider support
- Strong knowledge of health insurance concepts, benefits and eligibility, medical terminology, and claims lifecycle management
- Strong English verbal and written communication skills
- High attention to detail, sound judgment, and analytical problem-solving skills
- Ability to multitask in a fast-paced, digital-first environment while maintaining accuracy and professionalism
- Proficiency in Microsoft Office Suite and customer service and/or claims processing systems
- Must support contact center hours of 8:00am–5:30pm ET
- Must participate in a rotating on-call schedule for urgent member and provider support
- Preferred: Associate or bachelor’s degree in healthcare administration, business, or related field
- Preferred: Familiarity with Availity Essentials, payer portals, and EDI standards
- Preferred: Familiarity with Genesys, ServiceNow, and other CRM tools
- Preferred: Familiarity with Facility, Physician, Ancillary, and Behavioral Health claim types
- Spanish proficiency is a plus
Benefits: