Member Advocate

This position is considered a work-from-home position as no formal office space/work location is provided; however, the Member Advocate conducts majority of his/her work within Partner nursing homes in Member Advocate-specific work region. 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.