Member Advocate

Blue Cross and Blue Shield of Kansas • Topeka, KS

16h • Hybrid

About The Position

The Member Advocate represents Blue Cross and Blue Shield of Kansas (BCBSKS) across various settings, including clinics, hospitals, and through community partnerships to support members of contracted BCBSKS members. The position is dedicated to improving member experience by acting as a liaison to help members navigate the complexities of healthcare and insurance, offering guidance and assistance in a personalized and accessible manner. The Member Advocate fulfills key member-experience responsibilities by assisting members with navigating through the complexities of insurance benefits and healthcare to make the experience simple, personal, and transparent. The position effectively leverages a myriad of skill sets to provide the member with a seamless healthcare experience, blending social work, educational, and customer service functions while assisting with their health and wellness needs. The member advocate understands members’ health insurance plans, interprets and explains benefits, and assists the member’s understanding of options that affect the member’s finances and addresses complex issues affecting the member’s healthcare. This position is responsible and accountable for building relationships and problem solving with members to assist them with their health and wellness needs. The member advocate connects members with BCBSKS and community resources with a focus on improving their customer experience. The member advocate is a healthcare professional with a true passion for providing exemplary service to our members. The Advocate provides members awareness of available healthcare and community resources to assist in navigating the health system. This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.

Requirements

• Must apply social work skills and experience over a wide scope of the organization’s operations and be able to handle extremely complex cases.
• Must maintain positive, open, and effective communications.
• The role demands adaptability, a passion for member advocacy, and the ability to foster positive relationships across diverse environments.
• Human relations, behavior modification and facilitation skills are critical.
• Must have experience with face-to-face interactions and knowledge of approaches used to motivate individuals.
• Must be able to work independently and have problem solving, decision making, influence, negotiation, and collaboration skills.
• Must be able to work effectively in a fast-paced environment with competing priorities.
• Proficient in the use of telephone, personal computer, and customary computer programs (Microsoft Office) and be able to work with a variety of member tools/applications used to access health and insurance information and support member interactions of various communication channels (phone, in-person, chat, email, etc.)
• Bachelor's degree in Social Work, Sociology, Psychology, Human Development, Public Health, Community Health, Health Education, Health Promotion, or related degree.
• Minimum of three years' work experience in a public health, community health, workplace health programming, or clinical nursing setting.
• Current unrestricted Kansas clinical/social worker licensure (e.g., LBSW, LMSW, LSCSW).
• Capable of complying with all laws and regulations regarding the operation and the use of a motor vehicle for travel to / from designated work clinic site(s).
• Must have valid state driver license.

Nice To Haves

• Masters preferred in Social Work, Sociology, Psychology, Human Development, Public Health, Community Health, Health Education, Health Promotion, or related degree.
• For social work, attendance at a CSWE-accredited MSW program preferred for KS licensure.
• Experience as a care/clinical navigator or patient advocate preferred.
• Experience in public speaking and/or group presentations preferred.
• Ability to speak fluent English and Spanish preferred.

Responsibilities

• Coordinates healthcare navigation questions and issues by listening to member and dependents, gathering details, developing acceptable resolutions, and following up on outcomes.
• Educates and works with members at different educational and health literacy levels in a culturally sensitive manner.
• Assesses the member’s need for education and tailors teaching to the member’s knowledge level and learning style.
• Communicates effectively, verbally, in writing, via telephone, and in person.
• Effectively presents information and responds to questions from groups of managers, clients, customers, and the general public.
• Ability to speak comfortably in small or large groups for interpersonal and interdisciplinary collaboration regarding member needs and available services.
• Maintains member confidence by keeping information confidential.
• Handles extremely complex cases with skills and experience over a wide scope of the organization’s operations and functions, which may cross numerous organizational boundaries.
• Builds and maintains relationships with patients/families, clinical staff, community service providers, community leaders, and stakeholders within the BCBSKS organization.
• Establishes a trusted partnership with the member and builds creditability through knowledge sharing and collaboration around healthcare and benefit needs.
• Utilizes organizational, time management and prioritization skills to effectively manage multiple member inquiries, needs and issues with varying deadlines and urgencies.
• Defines problems, collects data, establishes facts, and draws valid conclusions and action plans.
• Utilizes independent, critical thinking, problem solving and decision-making regarding the provision or referral of services to patients/families with medical, emotional, and social needs.
• Exhibits influence, persuasion, and negotiation skills in leading to resolution of identified needs, issues or conflicts that members may experience with services received or not received.
• Determines the effectiveness of either owning or delegating a resolution to other responsible resources within the healthcare setting, the community or the BCBSKS organization.
• Executes judgement and discretion that is imperative to determine appropriate sources, directions, and parameters necessary to review and resolve issues in an extremely diverse, complex, and challenging environment.
• Operates successfully in an ambiguous environment that requires a degree of adaptability, agility, and reliability.
• Maintains positive personal influence, professional image, and integrity in promoting clinic, community and BCBSKS services.
• Works independently, with minimum direction and is self-motivated while successfully managing responsibilities.
• Improves quality results and outcomes by studying, evaluating, and re-designing member advocate processes and implementing changes as needed.
• Updates job knowledge by participating in educational opportunities, reading professional publications, maintaining personal networks, participating in professional organizations.
• Serves and protects the member by adhering to professional standards, following policies and procedures, and abides by federal, state, and local requirements.
• Enhances the member experience by accepting ownership for the role and exploring opportunities to add value to job accomplishments.
• Must support and exhibit the company’s values of integrity, dependability, service, growth and progress, and courage.
• Responsible for maintaining an awareness and understanding of the business unit recovery plan for the department and the corporation’s business continuity program in general.
• Refers members to case management, disease management, and other programs as appropriate.
• Collaborates with organizational partners throughout the state to align strategies.
• Represents BCBSKS at events, when appropriate, to further knowledge and relationships in the field.
• Must follow current URAC standards for essential job functions.
• Capable of complying with all laws and regulations regarding the operation and the use of a motor vehicle for travel to / from designated work clinic site(s).
• Must have valid state driver license.
• Schedule will require work hours which will include evenings.
• Must be able to travel, including overnight.

Benefits

• Base compensation is only one component of your competitive Total Rewards package
• Incentive pay program (EPIP)
• Health/Vision/Dental insurance
• 6 weeks paid parental leave for new mothers and fathers
• Fertility/Adoption assistance
• 2 weeks paid caregiver leave
• 401(k) plan matching up to 5%
• Tuition reimbursement
• Health & fitness benefits, discounts and resources

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 501-1,000 employees