Remote Member Advocate and Benefits Concierge

Convey Health Solutions; United States; Remote; USD 36,000 - 54,000; Full time

Job summary

Convey Health Solutions is seeking a Member Services Advocate to assist members with account updates, educate on plan benefits, and resolve premium billing discrepancies.

You will handle inbound and outbound calls, verify formulary coverage, maintain accurate member records, and escalate issues when needed. A high school diploma and 2 years in a fast-paced, high-volume environment are required. Healthcare experience is a plus, with strict HIPAA/CMS compliance.

Qualifications

• High school diploma required.
• Minimum 2 years experience in a fast‑paced, high‑volume call‑center, retail customer service, or hospitality environment.

Responsibilities

• Assist members with account updates (billing options, address/phone changes).
• Research and resolve premium billing discrepancies and prescription claims.
• Educate beneficiaries about plan benefits, cost sharing, and coverage levels.
• Submit mail requests for ID cards and formularies.
• Verify formulary coverage, tier, and copay for medicines; explain coverage gaps when applicable.
• Maintain compliance with CMS guidance and HIPAA regulations.
• Ensure accurate and detailed member record notations.
• Handle outbound calls to validate member information.
• Handle inbound calls, providing accurate assistance within defined response times.
• Escalate member issues to management when necessary.
• Maintain call quality metrics: 95% QA score, 80–85% answer rate within 30s, 90%+ schedule adherence, 98% attendance, and average handle time below standard.

Education

High school diploma

Job description

Convey Health Solutions is seeking a Member Services Advocate to assist members with account updates, educate on plan benefits, and resolve premium billing discrepancies.

You will handle inbound and outbound calls, verify formulary coverage, maintain accurate member records, and escalate issues when needed. A high school diploma and 2 years in a fast-paced, high-volume environment are required. Healthcare experience is a plus, with strict HIPAA/CMS compliance.