Member Advocate

POSITION SUMMARY

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.

ESSENTIAL FUNCTIONS

- 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.

EDUCATION

- High school diploma or equivalent required.

EXPERIENCE AND SKILLS

- 1 to 2 years of Customer Service experience required

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

- 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.

POSITION COMPETENCIES

- Accountability

- Communication

- Customer Service Orientation

- Functional/Technical Skills

- Quality Focus

- Time and Task Management

PHYSICAL DEMANDS

- This is a standard desk role requiring extended sitting and computer work.

WORK ENVIRONMENT

- Remote

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive .

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Compensation is not limited to base salary.  Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.

Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time.  All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process.  It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.