Member Advocate

American Health Plans; Jackson (MS); On-site; USD 42,000 - 65,000; Full time

Job summary

American Health Plans in Jackson, MS seeks a member advocate to lead customer service initiatives for the elderly within the local network. The role focuses on ensuring smooth enrollment-to-service transitions and serving as the main contact for families.

You will coordinate with providers, maintain monthly member contact, and ensure CMS regulatory compliance while providing timely updates and reporting across facilities in the region.

Qualifications

• Experience in healthcare with elderly patients: clinician, social worker or caregiver.
• Nursing home experience preferred.
• Exceptional interpersonal skills and the ability to work independently.
• Must be a good listener to understand family feedback.
• Travel to facilities within the assigned region; valid driver license and clean record.

Responsibilities

• After enrollment, coordinate with Insurance Producer to ensure a seamless transition.
• Follow up with members to answer questions and provide updates.
• Act as a front-line contact for members, facilities and care team.
• Develop and maintain relationships with network providers/facilities.
• Meet with the member/family monthly.
• Report on items members are dissatisfied with to the plan.
• Maintain reports on member status, calendars, and issues.
• Ensure all interactions comply with CMS regulations.
• Oversee services for the assigned group of nursing facilities.
• Other responsibilities as assigned.

Skills

Interpersonal skills

Customer service

Communication

Organizational skills

Teamwork

Written communication

Verbal communication

Driver license

Education

Associates or better

Tools

Microsoft Office

Job description

American Health Plans
Jackson, MS 39056, USA

American Health Plans
Jackson, MS 39056, USA

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

Skills

Behaviors

:

Motivations

:

Education

Preferred

Associates or better.

Experience

Licenses & Certifications

Required

Driver License

Equal Opportunity Employer
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