Member Advocate

Ultipro; Bloomington (IN); On-site; USD 50,000 - 75,000; Full time

Job summary

American Health Plans in Bloomington, IN is seeking a Member Advocate to support local service areas. You will coordinate with the Insurance Producer to ensure a smooth enrollment-to-service transition and act as a dedicated contact for members and families.

You will engage with nursing facilities and care teams, maintain regional provider networks, and meet with members monthly. Strong CMS compliance and excellent communication are essential.

Qualifications

• Experience in healthcare delivery with elderly patients (clinician, social worker, or caregiver).
• Excellent interpersonal and listening skills; ability to work independently or in a team.
• Ability to coordinate with nursing homes, doctors and admin staff in the region.
• Proven track record of delivering outstanding customer service.
• Compliance with CMS regulations for Medicare Advantage plans.

Responsibilities

• Coordinate with Insurance Producer to ensure seamless enrollment to customer service handoff.
• Follow up with members and family to answer questions and provide plan updates.
• Serve as front-line contact with members, facilities, and care teams to meet needs.
• Build and maintain relationships with network providers/facilities in assigned region.
• Meet with members/families monthly and track issues and calendar activities.
• Ensure compliance in all member interactions and reporting.

Skills

Interpersonal skills

Customer service

CMS compliance

Verbal/written communication

Team collaboration

Travel readiness

Microsoft Office

Organizational skills

Driver's license

Education

Associates degree

Tools

Microsoft Office Suite

Job description

American Health Plans
Bloomington, IN, USA

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 spaceallowing for productive office environment.

Insurance or Insurance Customer Service License is preferred; however, not required.

Preferred

Associates or better.

Licenses & Certifications

Required

Driver License

Equal Opportunity Employer
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