Member Advocate

American Health Advantage needs a customer‑service focused leader to support local service areas.

Responsibilities

• After a member is enrolled, coordinate with the Insurance Producer to ensure a seamless transition between enrollment and customer‑service success.
• Follow up with the member after enrollment to answer questions, act as a point of contact for the member or their family, and provide periodic updates about the plan.
• Provide 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 the assigned region and 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 members are dissatisfied with and report to the plan accordingly.
• Develop and maintain reporting, including managing member status, daily/weekly/monthly facility calendar, and issues tracking/management.
• Ensure that all interactions with the member are compliant with CMS regulations.
• Oversee a group of nursing facilities, ensuring that the above services are carried out for each member in the assigned group of facilities.
• Perform other responsibilities as assigned.

Qualifications and Requirements

• Experience successfully working in a healthcare delivery setting with elderly patients as a clinician, social worker, or caregiver; nursing‑home experience is preferred.
• Exceptional interpersonal skills with the ability to work independently and as part of a team; strong listening skills to understand family feedback.
• Ability to collaborate effectively with staff at nursing homes in the assigned region, including nursing staff, doctors, and administration.
• Proven track record of delivering outstanding customer service.
• Compliance with CMS regulations regarding Medicare Advantage plans at all times.
• Exceptional organizational skills.
• Strong written and verbal communication skills, with the ability to synthesize complex issues into simple 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 required.
• Strong proficiency with Microsoft Office Suite.
• Suitable home work space that allows for a productive office environment.
• Insurance or Insurance Customer Service license is preferred, but not required.