Regional Member Care Advocate

Ultipro; Seymour (IN); Remote; USD 50,000 - 70,000; Full time

Job summary

American Health Advantage seeks a customer-service focused leader to support local service areas. After a member is enrolled, coordinate with Insurance Producer to ensure a seamless transition between enrollment and ongoing customer service success, and serve as the primary contact for the member and family.

The Member Advocate will meet with members monthly, build relationships with regional providers, ensure CMS compliance in all interactions, and manage reporting on member status and

Qualifications

• Experience in healthcare delivery with elderly patients, clinician, social worker, or caregiver background.
• Excellent interpersonal and communication skills with ability to work independently and in a team.
• Ability to travel to facilities within the assigned region and maintain a valid driver's license.

Responsibilities

• Coordinate with Insurance Producer after enrollment to ensure a seamless transition to ongoing customer service.
• Follow up with members and families, addressing questions and providing plan support.
• Act as frontline contact for members, facilities, and care teams to meet plan needs.
• Develop and maintain relationships with regional network providers/facilities to meet network adequacy.
• Meet with members and/or families at least monthly and report on issues and satisfaction.
• Maintain reporting on member status, calendars, and issue tracking; ensure CMS compliance.
• Oversee a group of nursing facilities and ensure services are carried out for each member.
• Handle other responsibilities as assigned.

Skills

Interpersonal skills

Customer service

Communication

Organizational skills

Education

Associates degree

Tools

Microsoft Office Suite

Job description

American Health Advantage seeks a customer-service focused leader to support local service areas. After a member is enrolled, coordinate with Insurance Producer to ensure a seamless transition between enrollment and ongoing customer service success, and serve as the primary contact for the member and family.

The Member Advocate will meet with members monthly, build relationships with regional providers, ensure CMS compliance in all interactions, and manage reporting on member status and