Benefits Verification Specialist (WFH)

Start Date: August and September 2025 Class

# of Openings: 25
• You’ll act as a trusted guide, helping members navigate the complexities of their healthcare benefits while delivering high-quality support.
• Member Care Advocates are the most visible representatives of our mission to raise the standard of healthcare for everyone, everywhere.
• In this role, you will handle high-volume interactions and play a critical part in simplifying healthcare for members.
• If you're a driven, empathetic individual with a strong interest in helping people and solving problems, we want to hear from you.

Job Summary:

Responsibilities:
• Provide empathetic support: Answer inbound calls and chats from members, providers, and vendors, ensuring each interaction is respectful, compassionate, and solutions-oriented
• Advocate for members by taking ownership of their healthcare navigation needs , including:
• Assist members in resolving health plan-related questions, including claims and billing inquiries, prior authorizations, and benefits coverage.
• Facilitate access to virtual care services, second opinions from an expert, and other healthcare resources.
• Own the member journey: Take full ownership of member issues from start to finish, researching and resolving complex cases to minimize member effort
• Empower members through education: Help members understand their available benefits and guide them in accessing the services that best meet their needs
• Leverage internal and external resources: Research internal tools and external benefits to determine the best course of action, ensuring accurate and actionable information is provided
• Utilize tools and technology: Demonstrate proficiency with Included Health’s required systems to navigate and document member interactions effectively
• Represent the mission: Clearly articulate Included Health’s mission and fully understand the scope of our services to deliver consistent, high-quality advocacy
• Drive member satisfaction: Ensure all interactions meet quality standards, focusing on delivering empathetic, efficient, and member-focused service

Key Success Metrics:
• Availability and adherence: Maintain a consistent presence for members while adhering to an assigned schedule.
• Quality of Interactions: Demonstrate high standards in service, performance on audits, and member satisfaction surveys.
• Impactful Advocacy: Effectively represent member needs, connect them to valuable resources, and champion their healthcare journey.

Qualifications:
• Education and experience: Bachelor’s degree or 5 years relevant experience in healthcare (preferred)
• Comfort with high-volume inbound phone work: Familiarity with VoIP phone systems (e.g., CXOne) and comfortable handling a high volume of calls l throughout the entire day
• Technical proficiency: Strong familiarity with with Google apps, Apple products, and customer relationship management software, and ability to adapt to proprietary tools quickly
• Customer service excellence:Exceptional customer service skills, with the ability to act as a member advocate and prioritize their needs.

Communication skills:
• Verbal: Ability to confidently explain services, maintain a professional and friendly phone demeanor, and handle challenging conversations effectively.
• Written: Strong business writing skills in English, including accurate spelling, grammar, and clarity. Ability to communicate with members and providers in writing.
• Critical thinking and problem-solving: Demonstrated ability to think critically and use your resources to problem solve complex situations
• Confidentiality and compliance: Understands and follows HIPAA guidelines and regulations and maintains member confidentiality at all times
• Remote work readiness: Ability to work from a secure home office, free from distractions, with the discipline to succeed in a remote environment

Join our network of talented professionals!

Job Type: Full-time

Pay: $18.00 - $19.50 per hour

Benefits:
• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Application Question(s):
• Do you have any experience in assisting members with EOB, deductibles, or copayments?

Work Location: Remote

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