Member Advocate

Ultipro; Fort Wayne (IN); On-site; USD 50,000 - 70,000; Full time

Job summary

American Health Advantage seeks a customer-service focused leader to support local service areas and oversee a group of nursing facilities. The role involves coordinating enrollment and ongoing member support, serving as a primary contact for plans and family inquiries, and maintaining strong relationships with facilities and care teams.

Responsibilities include monthly member meetings, regional network development, and reporting while ensuring CMS compliance.

Qualifications

• Experience in healthcare delivery with elderly patients.
• Exceptional interpersonal and communication skills.
• Ability to coordinate with nursing staff, doctors and administration.
• Proven track record of delivering outstanding customer service.
• CMS regulation compliance knowledge or willingness to learn.
• Strong organizational and time-management skills.

Responsibilities

• Coordinate with Insurance Producer to ensure seamless enrollment and customer service.
• Follow up with members to answer questions and provide plan updates.
• Provide frontline support with members, partner facilities and care teams.
• Develop and maintain relationships with regional network providers/facilities.
• Meet with members and/or family monthly.
• Maintain reporting on member status, facility calendars and issues tracking.
• Ensure all interactions comply with CMS regulations.
• Responsible for a group of nursing facilities and related services.
• Other responsibilities as assigned.

Skills

Interpersonal skills

Communication

Customer service

Team collaboration

Travel readiness

Microsoft Office

Education

Associates or better

Tools

MS Office Suite

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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