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.

Responsibilities

• Coordinate with Insurance Producer after member 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 member and plan needs.
• 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.
• 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.

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