Member Advocate II

Centene Corporation • Remote-WI, WI

12d • $23 - $40 • Hybrid

About The Position

As a Customer Care professional at Centene, you will have the opportunity to make a significant impact on the lives of our 28 million members. Centene is a diversified, national organization that provides competitive benefits and a flexible approach to workplace arrangements. This hybrid role requires travel and is ideally suited for candidates residing in Wisconsin, particularly within the Milwaukee area. The core purpose of this position is to act as an advocate for members and a liaison between the Health Plan and Providers, ensuring access to care. You will establish a community presence, promote member education, and identify and resolve systemic barriers to care. Responsibilities include managing member complaints and grievances, serving as a primary contact for various advocacy groups and agencies, evaluating member eligibility for benefit programs, conducting field training and meetings, recommending process improvements, advising on contract compliance, and performing training and coaching for performance enhancement. You will also educate members and providers on policies and procedures, investigate and resolve access and cultural sensitivity issues, and participate in local community coalitions to understand and address member healthcare needs.

Requirements

• Associate’s degree or equivalent experience.
• 3+ years of public relations experience.
• Experience in working with diverse populations.
• Knowledge of health care, managed care, Medicare or Medicaid.
• Valid driver’s license.
• Must have a good driving record and the ability to travel.

Nice To Haves

• Candidate must reside in the state of WI, highly preferred that candidate resides within the Milwaukee area.
• Claims billing/coding knowledge preferred.
• Insurance producer license preferred.

Responsibilities

• Receive and respond to member complaints and formal grievances and identify potential access barriers and resolve as indicated in the grievance procedure.
• Serve as primary contact and liaison between member advocacy groups, human services agencies, providers and State entities.
• Evaluate member qualifications for better benefit entitlement programs.
• Conduct field trainings and face-to-face meetings with providers, members and community agencies and report results to senior management for any needed resolutions.
• Recommend changes in internal processes to affect provider and member satisfaction.
• Advise Health Plan on contract compliance in the delivery of covered services.
• Perform training, orientation and coaching for performance improvement within physician practices, community agencies, and health plan.
• Educate members and providers regarding policies and procedures related to benefits, website promotion and education.
• Investigate and resolve access and cultural sensitivity issues identified by internal departments, State staff, providers, advocacy organizations and members.
• Participate in local community coalitions to acquire knowledge and insight regarding the special health care needs of members and update and revise educational materials as appropriate.
• Performs other duties as assigned
• Complies with all policies and standards

Benefits

• competitive pay
• health insurance
• 401K
• stock purchase plans
• tuition reimbursement
• paid time off
• holidays
• a flexible approach to work with remote, hybrid, field or office work schedules.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree