Member Advocate

TruHealth•Springfield, MO

23h

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 by coordinating with Insurance Producers, serving as a point of contact for members and their families, and working with partner facilities and integrated care teams. The role is responsible for a group of nursing facilities and ensuring required services are carried out for each member assigned to those facilities. The position also involves maintaining provider relationships, supporting regional network development, tracking member status and issues, and ensuring all member interactions 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 carefully to understand feedback raised by family members.
Ability to work effectively with nursing staff, doctors, and administration staff at nursing homes in the assigned region.
Demonstrated ability to deliver outstanding customer service.
Compliance with CMS regulations regarding Medicare Advantage Plans.
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 in Microsoft Office Suite products.
Suitable home workspace that allows for a productive office environment.

Nice To Haves

Nursing home experience.
Insurance or Insurance Customer Service License.

Responsibilities

Coordinate with the Insurance Producer after enrollment to support a seamless transition and 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 to members, partner facilities, and the integrated care team to ensure member and plan needs are met.
Develop and maintain relationships with key network providers and facilities in the assigned region.
Support regional network development activities necessary to meet network adequacy requirements.
Meet with each member and/or their family at least monthly.
Follow up on member dissatisfaction and report issues 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.
Ensure the listed services are carried out for each member in the assigned group of nursing facilities.
Perform other responsibilities as assigned.