Job Description

About Texicare

Founded in 2023 as a mission-driven health affiliate of Texas Mutual, Texicare was created by a group of seasoned healthcare professionals, and is headquartered in Austin, Texas.

Texicare is committed to changing the healthcare landscape by providing small businesses with innovative solutions that increase access to easy-to-use, more affordable, quality health care for Texans and their families. Texicare’s vision is to transform the healthcare ecosystem for the better, helping to create a healthier and happier Texas. Our healthcare plans were designed to be used, to remove barriers to care, to truly make a difference in people’s lives.

We’re looking for passionate, mission-driven individuals to join us in creating a healthier and happier Texas.

Position Summary

As a Senior Customer Experience Advocate, you will serve as a subject matter expert and escalation point for complex member and stakeholder inquiries. You will help people understand their benefits, coverage, claims, billing, and provider networks, bringing sound judgment and clear, empathetic communication to each interaction.

You will take ownership of complex issues from initial review through resolution, coordinating with operational and support teams, keeping stakeholders informed, and ensuring accurate, timely follow-through. You will interpret plan documents and investigate claims or billing discrepancies, while maintaining thorough CRM documentation that supports a seamless experience and meets privacy and compliance standards.

You will also help direct day-to-day work by serving as a trusted resource for customer advocates. Through real-time guidance, coaching, quality feedback, and support for onboarding and training, you will strengthen team capability and reinforce consistent service standards. You will identify recurring issues and partner with leaders and cross-functional teams to improve processes, address root causes, and prevent future challenges.

If you are someone who has extensive call center customer service experience, strong knowledge of healthcare benefits and claims, and the judgment to manage sensitive situations with care, we want to hear from you! Apply today.

Essential Job Functions

In this role, you will be responsible for:

• Serving as a primary escalation point for complex or sensitive stakeholder inquiries across electronic correspondence, ensuring high-quality resolution and exceptional service delivery.
• Overseeing the lifecycle of complex stakeholder issues from initial discovery through final resolution, coordinating cross-functional efforts, ensuring timely follow-up, and maintaining clear, proactive communication.
• Acting as a trusted expert in benefits, policies, claims, and internal processes; provide guidance to team members and stakeholders on nuanced or high-impact scenarios.
• Identifying root causes of recurring issues, recommend and influence process improvements, and partner with leadership to implement solutions that enhance the overall customer experience.
• Documenting all customer interactions within the Customer Relationship Management (CRM) system to ensure a seamless member experience and to satisfy HIPAA, privacy, and internal regulatory audit standards.
• Analyzing and interpreting complex plan documents to provide authoritative guidance on eligibility, coverage, and cost-sharing.
• Leading the resolution of complex claims and billing discrepancies, including initiating and tracking escalations, reprocessing, and cross-departmental coordination to ensure accurate outcomes.
• Partnering with operational and support teams to identify systemic issues, validate data integrity, and ensure sustainable resolution of identified gaps.
• Serving as the team lead and go-to resource for customer advocates; provide real-time support, coaching, and mentorship to enhance team capability and performance.
• Supporting onboarding and ongoing training initiatives; developing and maintaining knowledge resources, best practices, and processing documentation to elevate team effectiveness.
• Modeling best-in-class service delivery; support quality assurance efforts by reviewing interactions, providing feedback, and reinforcing service standards across the team.

To be successful in this role, you must have:

• A high school diploma or equivalent required; associate or bachelor’s degree preferred.
• At least 4 years of experience working in a fast-paced call center environment, ideally in healthcare customer service.
• Experience supporting multiple communication channels (phone, chat, email).
• Working knowledge of health insurance terminology, claims processing, benefits, and/or provider services preferred.
• Demonstrated leadership skills, including the ability to guide and support teammates, contribute to daily team operations, and help move department priorities forward.
• Strong verbal and written communication skills.
• Demonstrated ability to work in a fast-paced, metric-driven environment.
• Proficiency with computer systems and ability to navigate multiple platforms simultaneously.
• A quiet, dedicated workspace, free from distraction to best serve stakeholders.

It would be great if you have:

• Are bilingual in English and Spanish.
• Have previous experience in a HIPAA-regulated environment.

Benefits

• Automatic 4% employer contribution to retirement plan
• 401k plan with 100% match up to 6%
• Flexible time off for vacation, illness, etc.
• Nine paid holidays
• Day one health, Rx, vision, and dental insurance
• Life and disability insurance
• Flexible spending account
• Pet coverage and pet Rx discounts
• Free identity theft protection
• Free 2nd medical opinion service

Location

Texicare offers a flex-hybrid environment centered around collaboration and connection. All employees must reside in Texas. Team members living in the Austin area are expected to work from our office at least two days per week. Those based outside the greater Austin area may work remotely within Texas, with occasional travel to Austin as needed.

Texicare is an equal opportunity employer.