Member Advocate

About the Role

A customer-service focused leader who supports local service areas by acting as the primary advocate for members enrolled in the plan, ensuring seamless transitions, ongoing support, and compliance with CMS regulations.

Responsibilities

• Coordinate with Insurance Producer post-enrollment to ensure a seamless transition and customer service success.
• Follow up with members to answer questions, act as their point of contact, and provide periodic plan updates.
• Serve as front-line support for members, partner facilities, and the integrated care team to meet member and plan needs.
• Develop and maintain relationships with key network providers and facilities within the assigned region.
• Support regional network development to meet network adequacy requirements.
• Meet with members and/or their families at least monthly.
• Address member dissatisfaction and report issues to the plan.
• Develop and maintain reporting for member status, facility calendars, and issues tracking.
• Ensure all member interactions comply with CMS regulations.
• Oversee a group of nursing facilities, ensuring services are carried out for all assigned members.
• Perform other responsibilities as assigned.

Requirements

• Experience working in a healthcare delivery setting with elderly patients as a clinician, social worker, or caregiver (nursing home experience preferred).
• Exceptional interpersonal skills with the ability to work independently and as part of a team.
• Strong listening skills to understand feedback from members and their families.
• Ability to collaborate effectively with nursing home staff, including nurses, doctors, and administration.
• Proven track record of delivering outstanding customer service.
• Compliance with CMS regulations for Medicare Advantage Plans.
• Exceptional organizational skills and strong written/verbal communication.
• Ability to simplify complex issues into clear messages.
• Willingness and ability to travel to facilities within the assigned region.
• Dependable transportation, a current driver’s license, a clean driving record, and proof of insurance.
• Strong proficiency in Microsoft Office Suite.
• Suitable home workspace for a productive office environment.

Qualifications

• Insurance or Insurance Customer Service License is preferred but not required.