Member Advocate

Career Center•Dallas, TX

12d

About The Position

American Health Advantage is seeking a customer-service-focused leader to support local service areas. The Member Advocate supports members after enrollment, coordinating with the Insurance Producer to help ensure a seamless transition and successful customer-service experience. The Advocate serves as a point of contact for members and their families, helps answer questions, provides assistance with the plan, and shares periodic plan updates. The role provides front-line support to members, partner facilities, and the integrated care team; develops relationships with network providers and facilities; and supports regional network development. The Member Advocate is assigned a group of nursing facilities and is responsible for delivering the specified services to each member in that group. The position requires regular facility visits, including meeting with members or their families at least monthly, and travel within the assigned region. All member interactions must comply with CMS regulations.

Requirements

Experience successfully working in a healthcare delivery setting with elderly patients as a clinician, social worker, or caregiver.
Exceptional interpersonal skills and the ability to work independently and as part of a team.
Ability to listen effectively to feedback raised by members’ families.
Ability to work well with nursing-home staff, including nursing staff, doctors, and administration staff.
Ability to deliver outstanding customer service, with a proven track record.
Comply with CMS regulations regarding Medicare Advantage Plans at all times.
Exceptional organizational skills.
Strong written and verbal communication and clear-thinking skills, including the ability to synthesize complex issues into simple messages.
Willingness and ability to travel to facilities within the assigned region.
Dependable transportation, a current driver’s license, a clean driving record, and proof of insurance.
Strong proficiency with Microsoft Office Suite products.
Suitable home workspace that allows for a productive office environment.

Nice To Haves

Nursing home experience is preferred.
An insurance or insurance customer service license is preferred, but not required.

Responsibilities

Coordinate with the Insurance Producer after enrollment to support a seamless transition and successful customer-service experience.
Follow up with enrolled members to answer questions, provide assistance to members or their families, and share periodic plan updates.
Provide front-line support as needed to members, partner facilities, and the integrated care team to help meet member and plan needs.
Develop and maintain relationships with key network providers and facilities in the assigned region.
Support regional network development activities needed to meet network adequacy requirements.
Meet with each member and/or their family at least monthly.
Follow up on member dissatisfaction and report relevant items to the plan.
Develop and maintain reporting, including member status, daily/weekly/monthly facility calendars, and issue tracking and management.
Ensure all interactions with members comply with CMS regulations.
Carry out the specified services for members in the assigned group of nursing facilities.
Perform other responsibilities as assigned.