Member Advocate

American Health Partners; New Orleans (LA); 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 and ensure member satisfaction with plan benefits. The role coordinates with Insurance Producers after enrollment, follows up with members, and acts as a primary contact for families needing plan information or assistance.

Strong communication and travel to facilities are expected. You will work with nursing facilities and providers, maintain relationships, and ensure CMS compliance across

Qualifications

• Experience in healthcare delivery with elderly patients (clinician, social work, or caregiver).
• Nursing home experience preferred.
• Strong interpersonal and teamwork skills; good listener.
• Excellent customer service track record.
• CMS regulations compliance experience is preferred.
• Excellent organizational, written, and verbal communication skills.
• Willingness to travel to facilities; valid driver's license and insurance.
• Proficient with Microsoft Office Suite.

Responsibilities

• Coordinate with Insurance Producer after enrollment to ensure seamless transition and customer service success.
• Follow up with members after enrollment to answer questions and provide plan assistance to the member or family.
• Serve as front-line support with members, partner facilities, and care teams to meet member and plan needs.
• Develop and maintain relationships with network providers/facilities to meet network adequacy requirements.
• Meet with members or family at least monthly.
• Follow up on items that members are dissatisfied with and report to the plan.
• Develop and maintain reporting on member status, facility calendars, and issues tracking.
• Ensure all member interactions comply with CMS regulations.
• Oversee services for a group of nursing facilities and ensure above services are carried out for all members in your facilities.
• Other responsibilities as assigned.

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 work 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.