Medicare Advantage Member Experience Specialist

BrightSpring Health Services; Nashville (TN); On-site; USD 52,000 - 78,000; Full time

Job summary

BrightSpring Health Services' Abilis Health Plan in Louisville, Nashville, and other locations seeks a Health Plan Member Services Analyst to act as the primary contact for membership operations under the I/IE-SNP program. You will handle inquiries about benefits, authorizations, enrollments, and claims in compliance with CMS regulations.

Collaborating with interdisciplinary care teams and facility staff, you will ensure timely resolution, maintain accurate member records, and support education

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, 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.

Responsibilities

• Member Inquiry & Benefits Navigation: Provide accurate, timely 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, facility staff, and the plan's Interdisciplinary Care Team to support care coordination activities.
• Communicate relevant member service issues, unmet needs, or quality concerns to Care 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 Utilization Management and communicate status updates.
• Maintain complete records of all member interactions in CMS-compliant systems.
• Adhere to HIPAA privacy and security regulations.
• Complete CMS and SNP training; ensure documentation quality for audit readiness.
• Grievances, Appeals & Coverage Determinations: Intake, document, and process grievances/appeals per CMS timelines.
• Explain member rights under Appeals process, including IRE rights.
• Coordinate with Medical Management, Claims, and Compliance teams for timely resolution.
• Track and monitor open cases to ensure CMS timelines.
• Member Outreach & Education: Educate members and facility staff on accessing plan services and using provider networks.
• Assist with ANOC and EOC distribution and answering related questions.
• Coordinate and host facility/community member engagement events.

Skills

CRM experience

Communication skills

Empathy

Regulatory compliance

Attention to detail

Teamwork

Education

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

High school diploma or GED

Tools

CRM systems

Microsoft Office Suite

Healthcare data systems

Job description

BrightSpring Health Services' Abilis Health Plan in Louisville, Nashville, and other locations seeks a Health Plan Member Services Analyst to act as the primary contact for membership operations under the I/IE-SNP program. You will handle inquiries about benefits, authorizations, enrollments, and claims in compliance with CMS regulations.

Collaborating with interdisciplinary care teams and facility staff, you will ensure timely resolution, maintain accurate member records, and support education