Health Plan 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

Overview

The Member Services Analyst for the Institutional and Institutional Equivalent Special Needs Plan (I/IE‑SNP) serves as the primary point of contact for membership operations. This role is responsible for delivering exceptional, person‑centered service to a uniquely vulnerable population by addressing inquiries related to benefits, authorizations, enrollments, claims, grievances, and appeals in full compliance with CMS regulations and the plan’s Model of Care (MOC).

Our Company

Abilis Health Plan

Responsibilities

• Provide accurate, timely, and empathetic information on Medicare Advantage benefits.
• Assist members and representatives in understanding the plan’s benefits and services.
• Facilitate enrollment, disenrollment, and plan change processes.
• Serve as a liaison between members, authorized representatives, facility nursing and social work staff, and the plan’s Interdisciplinary Care Team (ICT) to support care coordination activities.
• Communicate relevant member service issues, unmet needs, or quality concerns to assigned Care Managers or Case Managers for clinical follow‑up.
• Assist members and facility staff in understanding prior authorization requirements and status for institutional and ancillary services.
• Route authorization requests to the appropriate Utilization Management team and communicate status updates to requesting parties.
• Maintain complete and accurate records of all member interactions in the plan’s CRM or member management system in accordance with CMS and internal documentation standards.
• Adhere to all HIPAA privacy and security regulations in handling Protected Health Information (PHI).
• Complete all required CMS and plan‑mandated training on an ongoing basis, including Annual Compliance Training, SNP‑specific training, and Medicare Advantage regulations.
• Support audit readiness by ensuring documentation quality and accuracy consistent with plan policies.
• Intake, document, and process member grievances and appeals in accordance with CMS regulatory timeframes (standard and expedited).
• Explain member rights under the Medicare Advantage Appeals and Grievance process, including the right to request an Independent Review Entity (IRE) review.
• Coordinate with the Medical Management, Claims, and Compliance teams to ensure timely resolution and member notification.
• Track and monitor open cases to ensure adherence to required CMS timelines; escalate as needed.
• Educate members and facility staff on how to access plan services, how to request care, and how to use the plan’s provider network.
• Assist with Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) distribution and answer related questions during open enrollment periods.
• Coordinate and host facility and community member engagement events.

Qualifications

• High school diploma or GED required; Associate’s or Bachelor’s degree in Healthcare Administration, Social Work, Business, or related field preferred.
• Minimum of 2 years of experience in a healthcare member services, customer service, or health plan operations role.
• Prior experience in a Medicare Advantage, managed care, or long‑term care/post‑acute environment strongly preferred.
• Strong verbal and written communication skills with the ability to communicate complex benefit information in plain language.
• Demonstrated empathy and person‑centered communication skills, particularly with vulnerable elderly or disabled populations.
• Proficiency with CRM systems, member management platforms, and Microsoft Office Suite (Word, Excel, Outlook).
• Ability to manage a high volume of contacts while maintaining quality and regulatory compliance.
• Strong attention to detail and organizational skills, with the ability to prioritize and meet strict regulatory deadlines.
• Ability to work collaboratively within a multidisciplinary team environment.

About Our Line Of Business

Abilis Health Plan, an affiliate of BrightSpring Health Services, is a Medicare Advantage Plan covering all the benefits of Original Medicare (Parts A and B) with prescription drug coverage (Part D). The Abilis Health Plan is a unique plan allowing members to enroll year‑round. The plan focuses on members who meet residential requirements in participating nursing facilities. An interdisciplinary team of clinicians and innovative services allow us to meet each member’s clinical needs and provide preventive, coordinated, and quality healthcare. With a dedicated nurse practitioner leading a personalized care plan, we strive to improve the health of the communities in which we serve. For more information, please visit www.abilishealth.com.