Medical Insurance Policyholder Advocate

The schedule for this position is as follows: 6 Week Training: Monday through Friday, 8:00am-5:00pm MST (candidates required to honor the mountain standard time zone) Production Schedule: Monday through Friday, 10:00am-2:00pm MST (candidates required to honor the mountain standard time zone) JOB SUMMARY: The Medical Insurance Policyholder Advocate serves as a key liaison between members and healthcare providers. In this role, the Advocate helps facilitate communication, coordinates information, and supports smooth interactions related to benefits, services, and care access. The Advocate plays an essential role in ensuring clarity, accuracy, and timely resolution of issues involving members, providers, and internal teams. JOB DUTIES AND RESPONSIBILITIES:

• Serve as central point of contact between members, healthcare providers, and internal departments
• Facilitate communication regarding benefits, coverage, claims, authorizations, and billing questions
• Coordinate information exchange to support timely and accurate care delivery
• Assist providers and members in navigating plan requirements, processes, and available resources
• Research and resolve issues by collaborating with claims, provider relations, and customer service
• Track and document interactions, actions taken, and outcomes in case management systems
• Monitor open cases and follow up with members and providers to ensure resolution
• Support care coordination efforts by helping align services, referrals, and plan benefits
• Ensure compliance with HIPAA, privacy regulations, and organizational policies

JOB QUALIFICATIONS:

• High school diploma or GED
• 1-3 years of experience in healthcare administration, insurance, provider support, or customer service (or combination of experience and education)
• Strong communication skills with the ability to work effectively with both members and providers
• Ability to manage multiple cases, deadlines, and priorities
• Proficiency with computer systems and documentation tools
• Knowledge of health insurance processes, claims, authorizations
• Familiarity with medical terminology and healthcare systems
• Strong attention to detail and accuracy
• Ability to navigate complex systems and processes
• Professional, collaborative communication style
• Problem-solving mindset with a focus on resolution

CORE COMPETENCIES:

• Diversity & Inclusion: Demonstrates understanding and respect for diverse backgrounds; promotes a harassment-free workplace; supports inclusive practices.
• Ethics & Integrity: Acts with honesty, professionalism, and accountability; upholds organizational values.
• Customer Service: Responds promptly and professionally to inquiries; manages challenges with empathy and tact.
• Communication: Communicates clearly and confidently in both verbal and written formats; participates effectively in meetings and team settings.
• Motivation & Initiative: Pursues excellence; sets and meets high standards; overcomes challenges with persistence.
• Professionalism: Demonstrates respect, discretion, and reliability; takes ownership of responsibilities and follows through on commitments.
• Attendance & Punctuality: Maintains reliable attendance and punctuality; ensures coverage and communicates scheduling needs responsibly.

WORK-FROM-HOME REQUIREMENTS:

• Reliable high-speed internet and secure, quiet workspace
• Employee-provided WFH equipment
• * Desktop & Dual Monitors - 4vCPU with minimum 1.6 GHz or faster processor. For higher video/screen share resolution and frame rate, a four-core processor or better is required
• RAM: 8000 MB
• Hard Drive: 6 GB or more
• .NET Framework version 4.6.1 or later
• Windows 10/11
• Mouse
• Headset
• Webcam
• Comfortable using video conferencing tools throughout each scheduled shift
• Ability to maintain confidentiality and protect patient health information (PHI) in a remote environment

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