Member Advocate

About the Role

American Health Advantage needs a customer-service focused leader to support local service areas as a Member Advocate, responsible for a group of nursing facilities.

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 for plan assistance, and provide periodic plan updates.
• Serve as front-line support for members, partner facilities, and the integrated care team to meet the needs of both the member and the plan.
• Develop and maintain relationships with key network providers and facilities within the assigned region.
• Support regional network development activities to meet network adequacy requirements.
• Meet with members and/or their families at least monthly.
• Follow up on member dissatisfaction and report issues to the plan.
• Develop and maintain reporting, including member status, facility calendars, and issues tracking.
• Ensure all member interactions comply with CMS regulations.
• Carry out the above services for each member in the assigned group of facilities.
• 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 at all times.
• Exceptional organizational skills and strong written/verbal communication.
• Ability to synthesize complex issues into simple messages.
• Willingness and ability to travel to facilities within the assigned region, with dependable transportation, a valid driver’s license, 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.