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Personal Health Advocate
Health Advocate. Receive inbound member calls about healthcare issues including infertility, chronic disease, medications, and diagnoses .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in healthcare management, including member case ownership, effective communication of complex medical information, and collaboration with healthcare providers. Proficient in maintaining accurate documentation and navigating healthcare systems while ensuring compliance with HIPAA regulations.
Highest-signal resume keywords
BSN Or RN DegreeActive And Unrestricted State Or Multi-State Registered Nurse License3–5 Years Of Clinical And/or Medical Management ExperienceStrong Understanding Of Medical TerminologyExcellent Verbal Communication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical ManagementMedical TerminologyCase DocumentationHealthcare Systems NavigationBehavioral Health ExperienceProblem-Solving SkillsIssue-Resolution SkillsOrganizational AbilitiesProficiency In Microsoft WordProficiency In Microsoft Excel
Soft Skills
Effective ListeningProfessional Phone PresenceAbility To Explain Complex TopicsCollaboration SkillsAdaptability In Fast-Paced Environments
Industry Keywords
HIPAA CompliancePatient Care ProceduresHealthcare PracticesMember EngagementAppointment Coordination
About the role
Key responsibilities & impact- Receive inbound member calls about healthcare issues including infertility, chronic disease, medications, and diagnoses
- Assess member needs and determine appropriate actions according to policies, procedures, and KPIs
- Take ownership of member cases and encourage continued engagement
- Educate members about medical conditions, diagnostic testing, test results, and treatment options
- Explain complex medical and benefit information clearly and compassionately
- Provide healthcare provider and service options based on clinical needs, geographic location, and benefit coverage
- Research providers through credentialing, education verification, and medical-center affiliations
- Facilitate communication between members, physicians, and insurance carriers
- Assist with appointments, medical-record transfers, access issues, and benefit provisions
- Intercede to obtain earlier appointments or remove barriers to care
- Support members with prescriptions, pre-service fee negotiations, and authorization challenges
- Maintain accurate and timely case documentation
- Place outbound follow-up calls and respond to delegate box, answer service, and after-hours calls
- Escalate cases to supervisors or internal clinical resources
- Stay current on patient care procedures, diagnoses, authorizations, denials, and healthcare practices
- Mentor new team members and collaborate with colleagues to maintain service excellence
- Establish professional relationships with internal and external customers and meet departmental goals
Requirements
What you’ll need- BSN or RN degree from an accredited college or university (required)
- Active and unrestricted State or Multi-State Registered Nurse license (required)
- Minimum 3–5 years of clinical and/or medical management experience
- Behavioral and/or mental health experience strongly preferred
- Strong understanding of medical terminology and healthcare systems
- Excellent verbal communication skills and professional phone presence
- Ability to explain complex healthcare topics to diverse populations
- Highly effective listening, problem-solving, and issue-resolution skills
- Strong organizational and administrative abilities
- Proficiency with Microsoft Word and Excel
- Ability to work effectively in a collaborative, remote team environment
- Comfortable working in a fast-paced, high-volume phone environment
- Ability to document thoroughly and in real time
- Ability to work evening hours: 12–8:30 pm EST, 12:30–9 pm EST, or 1–9:30 pm EST
- Dedicated HIPAA-compliant workspace with reliable internet access
- Ability to perform prolonged sitting, continuous computer and phone use, repetitive motion, typing, concentration, reading, and ongoing verbal and written communication
Benefits
Comp & perks- Training provided
- Room for growth and internal promotion opportunities
- Fully remote work
- Dedicated HIPAA-compliant workspace requirement
- Reasonable accommodations for individuals with disabilities