Member Advocate

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

Responsibilities 

• After member is enrolled, coordine with Insurance Producer to ensure seamless transition between enrollment/customer service success is achieved.

• Once member is enrolled, follow up member to ensure th any questions are answered, act as a point of contact if the member or their family needs assistance with the plan, or provide them with periodic updes about the plan;

• Act as front-line support as needed with the member, partner facility and integred care team to ensure the needs of the Member and Plan are met;

• Develop and maintain relionships with key network providers/facilities within assigned region; support continued regional network development activities necessary to meet network adequacy requirements;

• Meet with the member and/or their family least monthly;

• Follow up on any items th the members are dissisfied with and report to plan accordingly;

• Develop and maintain reporting to include but not limited to managing member stus, daily/weekly/monthly facility calendar, issues tracking/management;

• Ensure th ALL interactions with the member are compliant with CMS regulions;

• The Member Advoce will be responsible for a group of nursing facilities; the Member Advoce is responsible for ensuring th the above services are carried out for each of the members in your assigned group of facilities;

• Other responsibilities as assigned.

  Qualificions/ Requirements

• Experience successfully working in a healthcare delivery setting with elderly pients as either a clinician, social worker or caregiver. Nursing home experience is preferred.

• Exceptional interpersonal skills with demonstred ability to work independently as well as with a team; must be a good listener to understand feedback raised by the family;

• Ability to work well with staff each of the nursing homes in the assigned region to include nursing staff, doctors and administrion staff;

• Ability to deliver outstanding customer service with a proven track record;

• Compliant, all times, with CMS regulions regarding Medicare Advantage Plans

• Exceptional organizional skills

• Strong written and verbal communicion and clear-thinking skills with the ability to synthesize complex issues into simple messages

• Willingness and ability to travel to facilities within your assigned region; have dependable transportion, a current driver’s license, a clean driving record, and proof of insurance;

• Strong proficiency in computer skills in Microsoft Office Suite products;

• Have suitable home work space allowing for productive office environment.

• Insurance or Insurance Customer Service License is preferred; however, not required.

Educion

• Associes or better

Licenses & Certificions

• Automobile Insurance
• Driver License

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further informion, please review the Know Your Rights notice from the Department of Labor.

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