Member Advocate

American Health Communities; Dallas (TX); Sur place; USD 55 000 - 65 000; Plein temps

Résumé du poste

American Health Communities seeks a Member Advocate to support local service areas, ensuring smooth transitions after enrollment and ongoing member assistance. You will maintain relationships with nursing facilities, coordinate with care teams, and ensure CMS compliance in every interaction.

The role requires travel to facilities within your region, strong communication, and a customer-service mindset to enhance member satisfaction and plan outcomes.

Qualifications

• Experience in a healthcare delivery setting with elderly or nursing home exposure preferred.
• Excellent interpersonal and listening skills with ability to work independently and in a team.
• Ability to coordinate with nursing homes, doctors and administration staff within the region.
• Strong customer service track record with CMS compliance knowledge or willingness to learn.

Responsabilités

• Coordinate with Insurance Producer after enrollment to ensure seamless transition and support.
• Follow up with members and families to answer questions and provide plan updates.
• Serve as front-line contact with members, facilities, and care team to meet member and plan needs.
• Develop and maintain relationships with regional providers/facilities to meet network adequacy requirements.
• Meet with members and/or their families monthly.
• Report and address member dissatisfactions and share issues with the plan.
• Maintain reporting on member status and facility calendars; track issues.

Connaissances

Interpersonal skills

Communication skills

Organizational skills

Travel willingness

MS Office

Active listening

Team player

Formation

Associates degree

Outils

Microsoft Office

Description du poste

American Health Plans- North Dalls, TX
Dallas, TX, 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

• Driver License

Equal Opportunity Employer
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