Member Advocate

Career Center • St Louis, MO

6d

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, working with Insurance Producers to help ensure a seamless transition and successful customer-service experience. The Advocate follows up with members to answer questions, provide assistance to members and their families, and share periodic plan updates.

The Member Advocate serves as front-line support for members, partner facilities, and the integrated care team; builds relationships with network providers and facilities; and supports regional network development. The role is responsible for a group of nursing facilities and for ensuring that each member in the assigned group receives the required services. The Advocate meets with members and/or families at least monthly, follows up on dissatisfaction and reports issues to the plan, maintains member and facility tracking reports, and ensures all member interactions comply with CMS regulations. Other responsibilities may be assigned.

Requirements

• Experience working successfully 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 members' families.
• Ability to work effectively with nursing staff, doctors, and administrative staff at nursing homes in the assigned region.
• Ability to deliver outstanding customer service, with a proven track record.
• Ability to comply 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 computer skills, including proficiency with Microsoft Office Suite products.
• Suitable home workspace 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 a member enrolls to help ensure a seamless transition and successful customer-service experience.
• Follow up with enrolled members to answer questions, serve as a point of contact for members and their families, and provide periodic plan updates.
• Provide front-line support as needed to members, partner facilities, and the integrated care team to help 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 needed to meet network adequacy requirements.
• Meet with each member and/or their family at least monthly.
• Follow up on matters with which members are dissatisfied and report them 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 required services are carried out for every member in the assigned group of nursing facilities.
• Perform other responsibilities as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed