Member Advocate

American Health Communities; Missouri; On-site; USD 42,000 - 62,000; Full time

Job summary

American Health Plans seeks a dedicated Member Advocate to support local service areas in Missouri. The role focuses on seamless enrollment transitions, ongoing member follow-up, and frontline support with members and facilities.

You will build relationships with nursing facilities and providers, ensure CMS compliance across interactions, and meet with members monthly to address needs and gather feedback for the plan. Local travel and strong communication are essential.

Qualifications

• Experience in healthcare delivery with elderly patients; nursing home experience preferred.
• Exceptional interpersonal skills; able to work independently and with a team.
• Ability to work well with nursing home staff, doctors and administration.
• Outstanding customer service track record.
• CMS regulations compliance for Medicare Advantage Plans.

Responsibilities

• Coordinate with Insurance Producer after enrollment to ensure seamless transition.
• Follow up with member to answer questions and provide periodic updates about the plan.
• Act as frontline support with member, partner facility and care team to meet needs.
• Develop and maintain relationships with network providers in the assigned region.
• Meet with the member and/or family at least monthly.
• Follow up on items causing dissatisfaction and report to plan.
• Develop and maintain reporting on member status, facility calendars, issues tracking.
• Ensure all interactions comply with CMS regulations.
• Advocate for a group of nursing facilities to ensure services for all members.
• Other responsibilities as assigned.

Skills

Interpersonal skills

Independent work

Teamwork

Customer service

CMS regulations

Organizational skills

Communication

Travel readiness

Microsoft Office

Education

Associates or better

Tools

Microsoft Office Suite

Job description

American Health Plans
St Louis, MO 63101, 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/ 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.

Preferred

• Associates or better.

Required

• Driver License

Equal Opportunity Employer
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