Member Advocate

American Health Partners; Ashland (KY); Hybrid; USD 42,000 - 64,000; Full time

Job summary

American Health Advantage seeks a customer-service focused leader to support local service areas and ensure seamless enrollment-to-service transitions.

The role involves coordinating with insurers, following up with members and families, and serving as a frontline liaison among members, facilities, and care teams. Travel to facilities in the region is expected to maintain strong provider networks and service quality.

Qualifications

• Experience in healthcare delivery settings, especially with elderly patients (clinical, social work, or caregiver roles).
• Nursing home experience preferred but not required.
• Exceptional interpersonal and communication skills with the ability to listen and respond to families.

Responsibilities

• Coordinate with Insurance Producer after enrollment to ensure smooth transitions.
• Follow up with members and families to answer questions and provide plan updates.
• Serve as front-line support with members, partner facilities and care team to meet member and plan needs.
• Build and maintain relationships with network providers/facilities in the region to support network adequacy.
• Meet with members or families at least monthly.
• Escalate and report any member dissatisfaction and track issues.
• Maintain reporting on member status and facilities calendars; monitor issues.
• Ensure all member interactions comply with CMS regulations.
• Oversee services for a group of nursing facilities within assigned region; ensure consistent service delivery.
• Perform additional duties as assigned.

Skills

Interpersonal skills

Customer service

Written and verbal communication

Organizational skills

Analytical thinking

Willingness to travel

Job description

American Health Advantage needs a customer-service focused leader to support local service areas.

Responsibilities

• After member is enrolled, coordinate with Insurance Producer to ensure seamless transition between enrollment/customer service success is achieved.
• Once member is enrolled, follow up member to ensure that any questions are answered, act as a point of contact if the member or their family needs assistance with the plan, or provide them with periodic updates about the plan;
• Act as front-line support as needed with the member, partner facility and integrated care team to ensure the needs of the Member and Plan are met;
• Develop and maintain relationships with key network providers/facilities within assigned region; support continued regional network development activities necessary to meet network adequacy requirements;
• Meet with the member and/or their family at least monthly;
• Follow up on any items that the members are dissatisfied with and report to plan accordingly;
• Develop and maintain reporting to include but not limited to managing member status, daily/weekly/monthly facility calendar, issues tracking/management;
• Ensure that ALL interactions with the member are compliant with CMS regulations;
• The Member Advocate will be responsible for a group of nursing facilities; the Member Advocate is responsible for ensuring that the above services are carried out for each of the members in your assigned group of facilities;
• Other responsibilities as assigned.

Qualifications/ Requirements

• Experience successfully working in a healthcare delivery setting with elderly patients as either a clinician, social worker or caregiver. Nursing home experience is preferred.
• Exceptional interpersonal skills with demonstrated ability to work independently as well as with a team; must be a good listener to understand feedback raised by the family;
• Ability to work well with staff at each of the nursing homes in the assigned region to include nursing staff, doctors and administration staff;
• Ability to deliver outstanding customer service with a proven track record;
• Compliant, at all times, with CMS regulations regarding Medicare Advantage Plans
• Exceptional organizational skills
• Strong written and verbal communication and clear-thinking skills with the ability to synthesize complex issues into simple messages
• Willingness and ability to travel to facilities within your assigned region; have dependable transportation, a current driver’s license, a clean driving record, and proof of insurance;
• Strong proficiency in computer skills in Microsoft Office Suite products;
• Have suitable home work space allowing for productive office environment.
• Insurance or Insurance Customer Service License is preferred; however, not required.