Compassionate Medicare Advantage Member Services Analyst

Abilis Health Plan; Indianapolis (IN); On-site; USD 45,000 - 60,000; Full time

Job summary

Abilis Health Plan is seeking a Member Services Analyst for its Medicare Advantage program in the Indianapolis area. The role serves as the primary contact for membership operations, delivering empathetic, person-centered service to a vulnerable population while addressing benefits, enrollments, authorizations, claims, grievances, and appeals in compliance with CMS regulations and the plan’s MOC.

You will collaborate with the Interdisciplinary Care Team, assist with enrollment processes, and

Qualifications

• High school diploma or GED required; associate/bachelor's preferred.
• Minimum of 2 years in healthcare member services, customer service, or health plan operations.
• Prior Medicare Advantage or managed care experience preferred.
• Strong verbal and written communication; ability to explain complex benefits clearly.
• Empathy and person-centered communication with vulnerable populations.
• Proficiency with CRM systems and Microsoft Office.

Responsibilities

• Provide accurate information on Medicare Advantage benefits and services.
• Assist members and representatives in understanding plan benefits and services.
• Facilitate enrollment, disenrollment, and plan changes.
• Coordinate with Care Team to support care coordination activities.
• Communicate member service issues to Care Managers for clinical follow-up.
• Explain prior authorization requirements and status for services.
• Route authorization requests to Utilization Management and communicate updates.
• Maintain records of member interactions per CMS and plan standards.
• Adhere to HIPAA and privacy regulations for PHI.
• Complete CMS and SNP training; support audit readiness and documentation quality.
• Process member grievances and appeals within CMS timeframes.
• Explain member rights under Appeals and Grievance processes, including IRE rights.
• Collaborate with Medical Management, Claims, and Compliance to resolve issues.
• Track open cases and escalate to meet CMS timelines.
• Educate members and facility staff on accessing plan services and provider networks.
• Assist with ANOC and EOC distribution and related inquiries.
• Coordinate and host facility and community engagement events.

Skills

Verbal communication

Written communication

Empathy

Regulatory compliance

Education

High school diploma or GED

Associate's or Bachelor's degree in Healthcare Administration, Social Work, Business, or related field

Tools

CRM systems

Microsoft Office

Job description

Abilis Health Plan is seeking a Member Services Analyst for its Medicare Advantage program in the Indianapolis area. The role serves as the primary contact for membership operations, delivering empathetic, person-centered service to a vulnerable population while addressing benefits, enrollments, authorizations, claims, grievances, and appeals in compliance with CMS regulations and the plan’s MOC.

You will collaborate with the Interdisciplinary Care Team, assist with enrollment processes, and