Member Advocate

About the role

A customer-service focused leader who supports local service areas by acting as the primary point of contact for enrolled members, their families, and network providers to ensure seamless transitions and ongoing satisfaction.

Responsibilities

• Coordinate with Insurance Producer after member enrollment to ensure a seamless transition and customer service success.
• Follow up with members to answer questions, provide plan updates, and assist with any needs from the member or their family.
• Act 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.
• 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 at all times.
• Exceptional organizational skills and strong written/verbal communication abilities.
• 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.