Member Advocate

American Health Communities; Springfield (MO); On-site; USD 55,000 - 75,000; Full time

Job summary

American Health Advantage is seeking a customer-service focused leader to support local service areas. You will coordinate with Insurance Producers, ensure seamless transitions after enrollment, and act as the primary contact for members and families.

You will build relationships with network providers, travel within the region, ensure CMS compliance, and maintain calendars and reports. The role requires independent work, strong communication, and a commitment to high-quality member experience.

Qualifications

• Experience in healthcare delivery with elderly patients.
• Excellent interpersonal and listening skills.
• Ability to work independently and in a team.
• Ability to interact with nursing home staff and physicians.
• Commitment to CMS regulations and Medicare/MA requirements.
• Strong organizational and communication skills.
• Willingness to travel within the region with reliable transportation.
• Proficiency with Microsoft Office.
• Home workspace suitable for a productive environment.
• Insurance license preferred but not required.

Responsibilities

• Coordinate with Insurance Producer after enrollment to ensure seamless transition.
• Follow up with members to answer questions and provide updates.
• Serve as frontline support for members, facilities, and care team.
• Develop and maintain relationships with regional network providers/facilities.
• Meet with members and/or families at least monthly.
• Report member dissatisfaction to plan and track issues.
• Maintain reporting on member status and facility calendars.
• Ensure all interactions comply with CMS regulations.
• The Member Advocate oversees a group of nursing facilities and services for each facility.
• Perform other duties as assigned.

Skills

Healthcare delivery experience

Interpersonal skills

Customer service excellence

CMS regulations compliance

Organizational skills

Communication skills

Travel willingness

Microsoft Office proficiency

Home office setup

Insurance license (preferred)

Education

Associates

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.

Qualifications

Education

Preferred

Associates

Licenses & Certifications

Required

Automobile Insurance

Driver License

Equal Opportunity Employer
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