Member Advocate I - 210113

TEKsystems

1d•$17 - $17•Remote

About The Position

The Member Advocate I serves as an advocate for members and a liaison between the Health Plan and providers to ensure access to care. This role establishes a community presence, promotes member education, and identifies and resolves systemic barriers that limit members’ access to appropriate healthcare services.

Requirements

High school diploma or equivalent.
Minimum 3 years of customer service experience in a healthcare environment.
Strong customer service and communication skills.
Ability to navigate multiple systems and adapt to changing workflows.
Knowledge of HIPAA compliance.
Team collaboration and problem‑solving abilities.

Nice To Haves

Medicare and/or Medicaid experience.

Responsibilities

Receive and respond to member complaints and formal grievances, identifying access barriers and resolving issues per grievance procedures.
Investigate and resolve access and cultural sensitivity issues raised by member services staff, state staff, providers, advocacy organizations, and recipients.
Participate in local community organizations to gain insight into members’ healthcare needs and update educational materials accordingly.
Serve as the primary contact for member advocacy groups, human services agencies, and state entities.
Maintain confidentiality in compliance with HIPAA guidelines.
Perform daily outreach calls using TruCare and OMNI systems (no inbound queue).
Collaborate with assigned buddy partners to resolve questions and share knowledge.
Attend bi‑monthly team meetings and monthly performance reviews via TEAMS.