Customer Engagement and Experience Member Advocate III

L.A. Care Health Plan•Los Angeles, CA

About The Position

The Customer Engagement and Experience Member Advocate III serves as a high-level resource and member support specialist within L.A. Care’s Customer Engagement and Experience operations. This position advocates and assists members in navigating their health plan benefits, accessing care, resolving issues, addressing waste and abuse, and connecting to community, clinical, and social services. The Customer Engagement and Experience Member Advocate III handles complex, sensitive, or escalated cases. Provides guidance to other advocates. Collaborates across departments to improve the member experience. This position plays a key role in supporting retention, satisfaction, and access to care for our underserved population. Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff.

Requirements

Associate's Degree In lieu of degree, equivalent education and/or experience may be considered.
At least 5 years of experience in member services, advocacy, care coordination, customer service, or healthcare navigation.
Experience working with vulnerable, underserved, and culturally diverse populations.
Experience resolving individual cases with regulatory state agencies.
Strong understanding of health plan benefits, medical terminology, and the healthcare delivery system.
Excellent communication, problem-solving, and conflict-resolution skills.

Nice To Haves

Bachelor's Degree in Healthcare or Related Field
Experience in Medicaid, Medicare, or managed care environments strongly preferred.
Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.
Ability to handle sensitive and complex member issues with compassion and professionalism.
Knowledge of community and social service resources.
Proficiency with CRM systems, case management tools, and documentation standards.
Strong organizational skills and ability to manage multiple priorities.
Knowledge of healthcare regulations and policies and procedures.
Excellent public speaking/public presentation skills.

Responsibilities

Assists members with complex benefit questions, care navigation challenges, grievances, access to services, and issue resolution.
Conducts high-touch outreach to support vulnerable or high-risk populations, including seniors, individuals with chronic conditions, and members with unmet social needs.
Serves as a subject matter expert for benefit interpretation, care coordination pathways, and service workflows.
Resolves escalated inquiries from customer service, care management, and provider relations.
Helps members understand coverage, Primary Care Physician (PCP) selection, referrals, authorizations, and healthcare system processes.
Connects members to community resources related to housing, food, transportation, financial assistance, behavioral health, and other social determinants of health (SDoH) needs.
Coordinates with cross-functional key stakeholders to remove barriers to care.
Supports member engagement initiatives such as health literacy outreach, preventive care reminders, redetermination support, and quality-improvement campaigns (e.g., Healthcare Effectiveness Data and Information Set (HEDIS), California Association of Health Plans (CAHPS)).
Participates in member experience programs focused on improving satisfaction, retention, and service outcomes.
Documents member feedback and identifies recurring pain points for operational improvement.
Works closely with cross-functional key stakeholders to address member needs.
Assists with complex cases requiring multi-department coordination.
Serves as a representative for Member Advocacy on workgroups or improvement projects.
Accurately documents all member interactions, interventions, and referrals in the plan’s systems.
Escalates potential quality-of-care issues, safety concerns, or compliance risks to appropriate teams.
Maintains confidentiality in accordance with Health Insurance Portability and Accountability Act (HIPAA) and managed care regulations.
Supports audit readiness through timely, accurate, and complete documentation.
Apply subject matter expertise in evaluating business operations and processes.
Identify areas where technical solutions would improve business performance.
Consult across business operations, provide mentorship, and contribute specialized knowledge.
Ensure that the facts and details are correct so that the program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices.
Provide training and recommend process improvements as needed.
Performs other duties as assigned.