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:

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