Member Advocate

Customer Service Leader

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

Responsibilities include:

• Coordinating with Insurance Producer to ensure seamless transition between enrollment and customer service success.
• Following up with members to ensure any questions are answered, acting as a point of contact if the member or their family needs assistance with the plan, or providing them with periodic updates about the plan.
• Acting as 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.
• Developing and maintaining relationships with key network providers/facilities within assigned region; supporting continued regional network development activities necessary to meet network adequacy requirements.
• Meeting with the member and/or their family at least monthly.
• Following up on any items that members are dissatisfied with and reporting to plan accordingly.
• Developing and maintaining reporting to include managing member status, daily/weekly/monthly facility calendar, issues tracking/management.
• Ensuring that all interactions with the member are compliant with CMS regulations.
• Being responsible for a group of nursing facilities and ensuring that the above services are carried out for each of the members in your assigned group of facilities.
• Other responsibilities as assigned.

Qualifications/Requirements include:

• Experience successfully working in a healthcare delivery setting with elderly patients as either a clinician, social worker, or caregiver. Nursing home experience is preferred.
• Exceptional interpersonal skills with demonstrated 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 at each of the nursing homes in the assigned region to include nursing staff, doctors, and administration staff.
• Ability to deliver outstanding customer service with a proven track record.
• Compliant, at all times, with CMS regulations regarding Medicare Advantage Plans.
• Exceptional organizational skills.
• Strong written and verbal communication 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 transportation, 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.

Education: Associates or better preferred.

Licenses & Certifications: Automobile Insurance, Driver License required.

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