Member Advocate

American Health Plans; Seymour (IN); On-site; USD 42,000 - 64,000; Full time

Job summary

American Health Advantage is seeking a customer-service oriented leader to support local service areas and ensure enrollment and ongoing member support.

The Member Advocate will coordinate with Insurance Producers, follow up with families, and act as a primary contact for plan questions while keeping CMS regulations in mind. This role requires travel within the assigned nursing facility network and monthly meetings with members and families.

Qualifications

• Experience in a healthcare delivery setting with elderly patients is required.
• Nursing home experience preferred.
• Exceptional interpersonal skills with the ability to work independently and in a team.
• Ability to travel within the assigned region; valid driver's license and transportation.

Responsibilities

• Coordinate with Insurance Producer after enrollment to ensure smooth transition.
• Follow up with member to answer questions and provide plan assistance.
• Front-line support with member, facilities, and care team to meet needs.
• Develop and maintain relationships with network providers within the region.
• Meet with member/family at least monthly.
• Report member dissatisfaction to the plan.
• Maintain reporting on member status, calendars, and issues.
• Ensure all interactions comply with CMS regulations.
• Oversee a group of nursing facilities to carry out services.
• Other responsibilities as assigned.

Skills

Interpersonal skills

Communication

Organizational skills

Customer service

Attention to detail

Willingness to travel

Microsoft Office

Education

Associate degree or better

Driver License

Tools

Microsoft 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 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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