Member Advocate

Career Center • Springfield, 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, coordinating with the Insurance Producer to help ensure a seamless transition and successful customer-service experience. The Advocate follows up with members to answer questions, serves as a point of contact for members and their families, and provides periodic plan updates or assistance as needed.

The role provides front-line support to members, partner facilities, and the integrated care team; builds relationships with network providers and facilities; and supports regional network development activities needed to meet network adequacy requirements. The Member Advocate is responsible for a group of nursing facilities and must ensure the described services are provided to each member in the assigned group. The role also involves maintaining reporting and records, addressing member dissatisfaction, and ensuring all member interactions comply with CMS regulations.

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 effectively to understand feedback from families.
• Ability to work well 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 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, serve as a point of contact for members and their families, and provide periodic plan updates or assistance.
• Provide front-line support to members, partner facilities, and the integrated care team to help ensure the needs of the member and plan are met.
• Develop and maintain relationships with key network providers and facilities in the assigned region.
• Support ongoing 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 members 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