Member Advocate

TruHealth; Seymour, Northern (IN, KY); Hybrid; USD 45,000 - 65,000; Full time

Job summary

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

In this role, you will coordinate with Insurance Producer, follow up with members and families, provide plan information, and serve as front-line support for facilities and care teams, while ensuring CMS compliance.

Travel within the region is required; a current driver’s license and proof of insurance are expected.

Qualifications

• Experience in healthcare delivery with elderly patients as clinician, social worker or caregiver.
• Excellent interpersonal skills and ability to work independently or in a team.
• Ability to collaborate with nursing home staff, doctors and administration.
• Strong customer service track record and CMS regulatory compliance.
• Excellent organizational, written and verbal communication skills.
• Willingness to travel within the region; valid driver’s license and insurance.
• Proficient with Microsoft Office Suite; home office setup suitable.

Responsibilities

• Coordinate with Insurance Producer after enrollment to ensure seamless transition.
• Follow up with member to answer questions and provide plan updates.
• Act as front-line support with member, partner facility and care team.
• Develop and maintain relationships with regional providers/facilities.
• Meet with member and/or family at least monthly.
• Report and track member status, calendars and issues.
• Ensure all interactions comply with CMS regulations.
• Travel to facilities within the assigned region; maintain driving record.

Skills

Customer service

Communication

Teamwork

Attention to detail

Travel availability

Microsoft Office

Education

Associate degree 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

Skills

Behaviors

:

Motivations

:

Education

Preferred

Associates or better.

Experience

Licenses & Certifications

Required

Driver License

Equal Opportunity Employer
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