Member Advocate

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

Job summary

American Health Advantage seeks a patient-focused leader to guide local service areas and ensure high-quality member support. After enrollment, coordinate with Insurance Producer to smooth transitions and address member questions, acting as primary contact for families.

Responsibilities include frontline support with facilities and care teams, building provider relationships, meeting members monthly, tracking issues, and ensuring CMS compliance.

Qualifications

• Experience in a healthcare delivery setting with elderly patients preferred.
• Must comply with CMS regulations and maintain high ethical standards.
• Strong communication, listening, and problem-solving abilities.

Responsibilities

• Coordinate with Insurance Producer after enrollment to ensure smooth transitions.
• Follow up with members and families to answer questions and provide updates.
• Provide frontline support with facilities and care teams to meet member needs.
• Develop relationships with network providers and facilities within the region.
• Meet with members or families monthly and document status and issues.
• Maintain reporting on member status, calendars, and issues tracking.
• Ensure all interactions comply with CMS regulations.

Skills

Interpersonal skills

Communication skills

Organizational skills

Travel willingness

Driver License

Education

Associates or better

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 spaceallowing for productive office environment.

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

Qualifications

Education

Preferred

Associates or better.

Licenses & Certifications

Required

Driver License

Equal Opportunity Employer
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