Member Advocate

American Health Plans; Pennsylvania; On-site; USD 60,000 - 90,000; Full time

Job summary

American Health Advantage seeks a patient-focused leader to support local service areas and oversee member advocacy. You will coordinate enrollment after sign-up, answer questions, and act as the primary contact for members and their families.

You will build relationships with nursing facilities and providers, ensure CMS compliance, and supervise reporting on member status and calendars while traveling within the region as needed.

Qualifications

• Experience in healthcare delivery with elderly patients in a clinical, social work, or caregiver role; nursing home experience preferred.
• Exceptional interpersonal skills and ability to work independently and in a team.
• Ability to work with nursing staff, doctors, and administration across facilities.
• Proven track record of delivering outstanding customer service.
• Compliance with CMS regulations for Medicare Advantage plans.
• Strong organizational, written, and verbal communication skills.
• Willingness to travel to facilities within the assigned region; valid license and insurance.
• Proficiency in Microsoft Office Suite.
• Have a suitable home workspace for productive work from home.
• Insurance or Insurance Customer Service License preferred but not required.

Responsibilities

• Coordinate with Insurance Producer after enrollment to ensure seamless transitions and customer-service success.
• Follow up with members after enrollment to answer questions and provide periodic plan updates.
• Act as front-line support with members, partner facilities, and the care team to meet member and plan needs.
• Develop and maintain relationships with network providers/facilities within the region to support network adequacy.
• Meet with the member and/or family at least monthly.
• Follow up on items causing member dissatisfaction and report to the plan.
• Develop and maintain reporting on member status, facility calendars, and issue tracking.
• Ensure all interactions with members comply with CMS regulations.
• Oversee a group of nursing facilities to ensure services are carried out for each member.
• Handle other responsibilities as assigned.

Skills

Healthcare delivery

Interpersonal skills

Team collaboration

Customer service

CMS regulations

Travel readiness

MS Office

Education

Associates degree or better

Tools

MS Office Suite

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 space allowing for productive office environment.
• Insurance or Insurance Customer Service License is preferred; however, not required.

Education Preferred

• Associates or better

Licenses & Certifications Required

• Automobile Insurance
• Driver License

Equal Opportunity Employer

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