Health Plan Member Services Analyst

About the role

The Member Services Analyst for the Institutional and Institutional Equivalent Special Needs Plan (I/IE-SNP) serves as the primary point of contact for membership operations. This role is responsible for delivering exceptional, person centered service to a uniquely vulnerable population by addressing inquiries related to benefits, authorizations, enrollments, claims, grievances, and appeals in full compliance with CMS regulations and the plan's Model of Care (MOC).

Responsibilities

• Provide accurate, timely, and empathetic information on Medicare Advantage benefits.
• Absorb and relay member and representative inquiries about the plan’s benefits and services.
• Facilitate enrollment, disenrollment, and plan change processes.
• Serve as a liaison between members, authorized representatives, facility nursing and social work staff, and the plan's Interdisciplinary Care Team (ICT) to support care coordination activities.
• Communicate relevant member service issues, unmet needs, or quality concerns to assigned Care Managers or Case Managers for clinical follow-up.
• Aid members and facility staff in understanding prior authorization requirements and status for institutional and ancillary services.
• Maintain complete and accurate records of all member interactions in the plan's CRM or member management system in accordance with CMS and internal documentation standards.
• Adhere to all HIPAA privacy and security regulations in handling Protected Health Information (PHI).
• Complete all required CMS and plan-mandated training on an ongoing basis, including Annual Compliance Training, SNP-specific training, and Medicare Advantage regulations.
• Support audit readiness by ensuring documentation quality and accuracy consistent with plan policies.

Qualifications

• A high school diploma or GED is required.
• An Associate's or Bachelor's degree in Healthcare Administration, Social Work, Business, or a related field is preferred.
• Minimum of 2 years of experience in a healthcare member services, customer service, or health plan operations role.
• Prior experience in a Medicare Advantage, managed care, or long-term care/post-acute environment is strongly preferred.
• Strong verbal and written communication skills with the ability to communicate complex benefit information in plain language.
• Demonstrated empathy and person centered communication skills, particularly with vulnerable elderly or disabled populations.
• Proficiency with CRM systems, member management platforms, and Microsoft Office Suite (Word, Excel, Outlook).
• Ability to manage a high volume of contacts while maintaining quality and regulatory compliance.
• Strong attention to detail and organizational skills, with the ability to prioritize and meet strict regulatory deadlines.
• Ability to work collaboratively within a multidisciplinary team environment.

About Our Line of Business

Abilis Health Plan, an affiliate of BrightSpring Health Services, is a Medicare Advantage Plan covering all the benefits of Original Medicare (Parts A and B) with prescription drug coverage (Part D). The Abilis Health Plan is a unique plan allowing members to enroll year-round. The plan focuses on members who meet residential requirements in participating nursing facilities. An interdisciplinary team of clinicians and innovative services allow us to meet each member’s clinical needs and provide preventive, coordinated, and quality healthcare. With a dedicated nurse practitioner leading a personalized care plan, we strive to improve the health of the communities in which we serve. For more information, please visit www.abilishealth.com. Follow us on LinkedIn.