Member Advocate

American Health Communities; Fort Wayne (IN); Hybrid; USD 42,000 - 65,000; Full time

Job summary

American Health Advantage is seeking a proactive Member Advocate to support local service areas with enrollment follow-ups, family communications, and provider coordination. You will act as a liaison among members, facilities, and the care team to ensure compliant, high-quality patient experiences.

The role requires healthcare delivery experience, strong interpersonal skills, and the ability to travel within the assigned region. A driver license and proficiency with MS Office are needed.

Qualifications

• Experience in a healthcare delivery setting with elderly patients is required.
• Excellent interpersonal and communication abilities with the ability to work independently or in a team.
• Able to collaborate with nursing staff, doctors and administration in multiple facilities.

Responsibilities

• Coordinate with Insurance Producer after enrollment to ensure smooth transition and success.
• Follow up with members to answer questions and provide plan updates to the family.
• Serve as front-line contact with members, facilities and care teams to meet needs.
• Develop and maintain relationships with regional network providers/facilities to meet network adequacy.
• Meet with members or families at least monthly and report dissatisfaction items.
• Maintain reporting on member status, facility calendars, issues tracking.
• Ensure all interactions comply with CMS regulations.
• Oversee services for a group of nursing facilities and ensure tasks are carried out.
• Perform other duties as assigned.

Skills

Interpersonal skills

Customer service

Communication

Organization

Education

Associates or better

Tools

Microsoft Office

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 spaceallowing for productive office environment.

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

Qualifications

Education

Preferred

Associates or better.

Licenses & Certifications

Required

Driver License

Equal Opportunity Employer
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