Member Advocate

American Health Communities; St. Louis (MO); Presencial; USD 55.000 - 75.000; Jornada completa

Descripción de la vacante

American Health Advantage seeks a customer-service focused leader to support local service areas. The role coordinates with Insurance Producers and care teams to ensure seamless enrollment transitions and ongoing member support, while maintaining CMS-compliant interactions.

You will build and sustain relationships with network facilities, meet with families monthly, and travel as needed within the region to ensure plan success.

Formación

• Experience in a healthcare delivery setting with elderly patients or caregivers.
• Ability to navigate CMS regulations and Medicare Advantage Plans.
• Strong organizational skills and ability to manage multiple facilities.
• Proven customer service excellence with clear communication.
• Willingness to travel within the assigned region with valid license and insurance.

Responsabilidades

• Coordinate with Insurance Producer after enrollment to ensure seamless transitions.
• Follow up with members to answer questions and provide plan assistance.
• Provide front-line support with members, facilities, and care teams.
• Develop and maintain relationships with network providers within the region.
• Meet with members or families monthly to review needs.
• Address member dissatisfaction and report findings to the plan.
• Maintain reporting on member status, calendars, and issue tracking.
• Ensure all interactions comply with CMS regulations.
• Oversee services for a group of nursing facilities within the assigned region.
• Perform other duties as assigned.

Conocimientos

Interpersonal Skills

Customer Service

Communication

Travel Readiness

Team Collaboration

Educación

Associates

Herramientas

Microsoft Office Suite

Descripción del empleo

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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