Member Advocate

TruHealth•St. Louis, MO

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 Insurance Producers to ensure a seamless transition and serving as a point of contact for members and their families. The role provides front-line support to members, partner facilities, and the integrated care team, and helps ensure member and plan needs are met. The Member Advocate is responsible for a group of nursing facilities and the members assigned to those facilities. The role includes regular member and family meetings, follow-up on questions and dissatisfaction, relationship development with regional network providers, and maintaining reports on member status, facility calendars, and tracked issues. 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, including listening carefully to family feedback.
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.
Compliance at all times 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 in 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 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 customer-service success.
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, and 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 issues 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 specified services are carried out for all members in the assigned group of nursing facilities.
Perform other responsibilities as assigned.