Member Advocate

American Health Partners; Fort Worth (TX); On-site; USD 55,000 - 75,000; Full time

Job summary

American Health Advantage is seeking a customer-service focused leader to support local service areas. After enrollment, coordinate with Insurance Producer to ensure a seamless transition and ongoing support for members and families.

The role includes frontline support with members, facilities, and care teams, monthly member meetings, and regional network development to meet network adequacy. Travel within the assigned region is required.

Qualifications

• Experience in a healthcare delivery setting with elderly patients; nursing home experience preferred.
• Exceptional interpersonal skills with ability to work independently and in a team.
• Good listener to understand feedback raised by the family.
• Ability to collaborate with nursing staff, doctors and administration staff.
• Deliver outstanding customer service with a proven track record.
• Compliant with CMS regulations regarding Medicare Advantage Plans.
• Excellent organizational and communication skills.
• Willingness to travel; valid driver's license, clean driving record, proof of insurance.
• Insurance customer service license preferred but not required.

Responsibilities

• Coordinate with Insurance Producer after enrollment to ensure seamless transition between enrollment and customer service success.
• Follow up with members to answer questions and provide periodic plan updates.
• Act as front-line support with members, partner facilities, and care teams.
• Develop and maintain relationships with regional network providers/facilities.
• Meet with members and families at least monthly.
• Report on items members are dissatisfied with and escalate to the plan.
• Develop and maintain reporting for member status and facility calendars.
• Ensure all interactions comply with CMS regulations.
• Manage a group of nursing facilities and ensure services are carried out for each member.
• Perform other duties as assigned.

Skills

Interpersonal skills

Customer service

Listening skills

Communication skills

Organizational skills

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 space allowing for productive office environment.


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