Member Advocate

American Health Partners; Seymour (IN); On-site; USD 55,000 - 75,000; Full time

Job summary

American Health Advantage seeks a customer-service oriented leader to support local service areas and ensure seamless transitions after enrollment. You will act as a point of contact for members and families, providing updates and facilitating plan-related support.

The role requires coordinating with facilities and care teams, developing regional provider relationships, monthly member meetings, and strict CMS compliance across all activities.

Qualifications

• Experience in healthcare delivery with elderly patients (clinical, social work or caregiver).
• Excellent interpersonal and communication skills.
• Ability to work independently and in teams; strong listening.
• Willingness to travel to facilities; valid driver's license and insurance.
• Proficiency with Microsoft Office Suite.
• Familiarity with CMS regulations, Medicare Advantage.

Responsibilities

• Coordinate with Insurance Producer after enrollment for a smooth transition.
• Follow up with members and families to answer questions and provide plan updates.
• Provide frontline support for members, facilities, and care teams.
• Develop relationships with network providers and facilities in the region.
• Meet with members or families monthly.
• Report issues and maintain member status and schedules.
• Ensure all interactions comply with CMS regulations.
• Oversee services for a group of nursing facilities.
• Handle other assigned responsibilities.

Skills

Interpersonal skills

Customer service

CMS compliance

MS Office proficiency

Travel willingness

Valid driver’s license

Education

Healthcare background in elderly care

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