Member Advocate II

Hybrid role that will require travel. Candidate must reside in the state of WI; residence within the Milwaukee area is highly preferred.

Position Purpose

Act as an advocate for members and a liaison between the Health Plan and Provider(s) to ensure availability and access to care. Establish a community presence, promote member education, identify and resolve any systemic barriers that limit access to appropriate care.

• Receive and respond to member complaints and formal grievances and identify potential access barriers and resolve as indicated in the grievance procedure.
• Serve as primary contact and liaison between member advocacy groups, human services agencies, providers and State entities.
• Evaluate member qualifications for better benefit entitlement programs.
• Conduct field trainings and face-to-face meetings with providers, members and community agencies and report results to senior management for any needed resolutions.
• Recommend changes in internal processes to affect provider and member satisfaction.
• Advise Health Plan on contract compliance in the delivery of covered services.
• Perform training, orientation and coaching for performance improvement within physician practices, community agencies, and health plan.
• Educate members and providers regarding policies and procedures related to benefits, website promotion and education.
• Investigate and resolve access and cultural sensitivity issues identified by internal departments, State staff, providers, advocacy organizations and members.
• Participate in local community coalitions to acquire knowledge and insight regarding the special health care needs of members and update and revise educational materials as appropriate.
• Must have a good driving record and the ability to travel.
• Performs other duties as assigned.
• Complies with all policies and standards.

Requirements

• Associate’s degree or equivalent experience.
• 3+ years of public relations experience.
• Experience in working with diverse populations.
• Knowledge of health care, managed care, Medicare or Medicaid.
• Claims billing/coding knowledge preferred.
• Valid driver’s license.
• Insurance producer license preferred.

Pay

$23.23 - $39.61 per hour. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives.

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field or office work schedules

Benefits may be subject to program eligibility.