Member Care Advocate & Network Liaison

American Health Partners; Fort Worth (TX); 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. After enrollment, coordinate with Insurance Producer to ensure a seamless transition and ongoing support for members and families.

The role includes frontline support with members, facilities, and care teams, monthly member meetings, and regional network development to meet network adequacy. Travel within the assigned region is required.

Qualifications

• Experience in a healthcare delivery setting with elderly patients; nursing home experience preferred.
• Exceptional interpersonal skills with ability to work independently and in a team.
• Good listener to understand feedback raised by the family.
• Ability to collaborate with nursing staff, doctors and administration staff.
• Deliver outstanding customer service with a proven track record.
• Compliant with CMS regulations regarding Medicare Advantage Plans.
• Excellent organizational and communication skills.
• Willingness to travel; valid driver's license, clean driving record, proof of insurance.
• Insurance customer service license preferred but not required.

Responsibilities

• Coordinate with Insurance Producer after enrollment to ensure seamless transition between enrollment and customer service success.
• Follow up with members to answer questions and provide periodic plan updates.
• Act as front-line support with members, partner facilities, and care teams.
• Develop and maintain relationships with regional network providers/facilities.
• Meet with members and families at least monthly.
• Report on items members are dissatisfied with and escalate to the plan.
• Develop and maintain reporting for member status and facility calendars.
• Ensure all interactions comply with CMS regulations.
• Manage a group of nursing facilities and ensure services are carried out for each member.
• Perform other duties as assigned.

Skills

Interpersonal skills

Customer service

Listening skills

Communication skills

Organizational skills

Tools

Microsoft Office

Job description

American Health Advantage is seeking a customer-service focused leader to support local service areas. After enrollment, coordinate with Insurance Producer to ensure a seamless transition and ongoing support for members and families.

The role includes frontline support with members, facilities, and care teams, monthly member meetings, and regional network development to meet network adequacy. Travel within the assigned region is required.