Member Advocate

American Health Communities; Fort Worth (TX); Hybrid; USD 60,000 - 85,000; Full time

Job summary

American Health Plans in Fort Worth, TX is seeking a patient-focused leader to oversee local member services and care coordination within our network. The role emphasizes high-quality service for elderly members and collaboration with care teams.

You will coordinate enrollment transitions, follow up with members and families, ensure timely responses to questions, and maintain CMS-compliant reporting while building strong relationships with providers and facilities.

Qualifications

• Experience in healthcare delivery with elderly patients.
• Strong interpersonal and customer service skills.
• Familiar with CMS regulations.
• Excellent verbal and written communication.
• Willingness to travel within the assigned region.

Responsibilities

• Coordinate with Insurance Producer to ensure smooth enrollment transitions.
• Follow up with members and families to answer questions and provide plan updates.
• Serve as frontline support with members, facilities, and care team.
• Develop and maintain relationships with network providers/facilities.
• Meet with members monthly and track issues.
• Ensure CMS compliance in all member interactions.
• Travel within the assigned region with valid license and insurance.

Skills

Interpersonal skills

Customer service

CMS regulations knowledge

Excellent communication

Travel willingness

Education

Associates or better

Tools

Microsoft Office Suite

Job description

American Health Plans
Fort Worth, 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

• 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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