Member Advocate II

Jobtailor; Wisconsin; On-site; USD 50,000 - 70,000; Full time

Job summary

Jobtailor is seeking a dedicated Member Advocate in Wisconsin to help ensure access to care and strong patient advocacy. You will collaborate with health plans, providers and community groups to promote education, address barriers, and resolve member concerns.

Responsibilities include field outreach, trainings for providers, and reporting outcomes to leadership. The role requires 3+ years of PR experience, an associate degree, and willingness to travel within Wisconsin; a valid driver's license

Qualifications

• Associate degree or equivalent experience.
• 3+ years of public relations experience.
• Experience working with diverse populations.
• Knowledge of health care, managed care, Medicare or Medicaid.
• Good driving record and ability to travel within Wisconsin.

Responsibilities

• Advocate for members and liaise between the Health Plan and providers to ensure access to care.
• Establish a community presence and promote member education.
• Identify and resolve barriers limiting access to appropriate care.
• Receive and respond to member complaints and formal grievances.
• Serve as primary contact between member groups, human services agencies, providers and State entities.
• Educate members and providers on benefits-related policies and procedures.

Skills

Public relations

Diversity experience

Travel ability

Driver's license

Healthcare knowledge

Education

Associate degree or equivalent

Job description

• Act as an advocate for members and liaison between the Health Plan and providers to ensure availability and access to care
• Establish a community presence and promote member education
• Identify and resolve systemic barriers limiting access to appropriate care
• Receive and respond to member complaints and formal grievances
• Serve as primary contact and liaison between member advocacy groups, human services agencies, providers and State entities
• Evaluate member qualifications for better benefit entitlement programs
• Conduct field trainings and face-to-face meetings with providers, members and community agencies
• Report results to senior management and recommend needed resolutions
• Recommend internal process changes to improve provider and member satisfaction
• Advise the Health Plan on contract compliance in delivery of covered services
• Perform training, orientation and coaching for performance improvement
• Educate members and providers on benefits-related policies and procedures, website promotion and education
• Investigate and resolve access and cultural sensitivity issues
• Participate in local community coalitions
• Update and revise educational materials as appropriate
• Perform other duties as assigned
• Comply with all policies and standards

Requirements

• Associate’s degree or equivalent experience
• 3+ years of public relations experience
• Experience working with diverse populations
• Knowledge of health care, managed care, Medicare or Medicaid
• Good driving record
• Ability to travel
• Valid driver’s license
• Claims billing/coding knowledge preferred
• Insurance producer license preferred
• Must reside in Wisconsin; Milwaukee-area residence highly preferred

Core Competencies

Demonstrates expertise in member advocacy, community engagement, and health care compliance, with a strong focus on resolving access issues and improving member satisfaction. Proficient in educating diverse populations on benefits-related policies and conducting training for providers and community agencies.