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 Apply Job! Apply to this Job