Member Advocate

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.