Nurse Advocate

Job Description

Job Description

About Us

Main Street Insurance Group is one of the fastest growing trusted independent insurance agencies in the Southeast, offering a comprehensive suite of insurance solutions to protect clients from the unexpected. We don’t just sell insurance. We work closely with our clients to help them make important and informed decisions every day when it comes to protection and their future. Main Street Insurance Group has been in business for over 125 years, with our roots dating back to 1898 and to three small North Carolina communities. We work to create customized solutions for our clients with expertise in Business Insurance, Home Insurance, Auto Insurance, Employee Benefits and Equine Insurance. Today, we work with a variety of individuals and businesses throughout the Southeast, with locations in North Carolina, Georgia, and Tennessee. If you are an experienced professional who delivers best-in-class service and is looking for a rewarding, challenging and meaningful work environment – then Main Street Insurance Group is looking for you!

Nurse Advocate

Position Summary:

The primary function of this role is to provide personalized health and benefits advocacy services to clients and their employees, assisting them in navigating complex healthcare and insurance issues. This role combines clinical expertise with in-depth knowledge of health plan benefits to deliver high-touch support for medical, claims, and coverage concerns. Acting as a liaison between clients, healthcare providers, and insurance carriers, the Nurse Advocate ensures that members receive appropriate care, understand their benefits, and have their needs addressed with compassion and efficiency.

Key Responsibilities:

Member Support and Advocacy

• Provide individualized guidance to members regarding healthcare decisions, benefits utilization, and claims resolution.
• Assist clients in understanding diagnosis, treatment plans, and available care options.
• Coordinate with providers, carriers, and other stakeholders to facilitate access to appropriate services.
• Support members in navigating prior authorizations, appeals, and billing concerns.

Clinical Insight and Guidance

• Leverage nursing knowledge to explain medical terminology, procedures, and treatment options in understandable terms.
• Identify potential gaps in care and recommend solutions to improve health outcomes.
• Advocate for evidence-based treatment plans and appropriate levels of care.

Collaboration and Communication

• Work closely with the Advosee and benefits account management teams to address client needs.
• Serve as a trusted point of contact for escalated health-related issues.
• Maintain regular communication with members to ensure continuity of support.

Documentation and Compliance

• Accurately document all interactions in the agency management or advocacy tracking system.
• Ensure compliance with HIPAA and other regulatory requirements regarding patient privacy and data security.
• Track and report on advocacy activities and outcomes to support client reporting and internal process improvements.
• Perform other duties as assigned.

Qualifications:

• Registered Nurse (RN) with an active, unrestricted license in applicable state(s) required
• Minimum of three years of clinical experience, preferably in case management, patient advocacy, or health insurance navigation
• Strong knowledge of health insurance benefits, claims processes, and healthcare systems
• Experience working within an insurance brokerage, benefits administration, or healthcare coordination environment preferred
• Proficiency in Microsoft Office Suite and ability to learn agency and advocacy software systems
• Exceptional interpersonal and communication skills, with the ability to convey complex information in clear, empathetic language
• Problem-solving and conflict resolution skills with a member-first approach
• Limited travel will be required
• Ability to pass a criminal background check, as permitted by law

Hours: Monday-Friday, 8:00am-5:00pm

Work Environment: 

• 1523 Elizabeth Avenue, Suite 300, Charlotte, NC 28204 (Hybrid Work Options)
• Remote work opportunities available for qualified candidates residing in North Carolina

Benefits:

• Competitive Salary
• Health Insurance Plans (PPO, HSA, Copay Options)
• Dental Insurance
• Vision Insurance
• Company Paid Disability Insurance
• Supplemental Insurance including Critical Illness, Accident, Legal, Pet Insurance
• 401(k) with Safe Harbor Match
• Paid Time Off 
• Paid Holidays

No Solicitation Notification to Agencies:  Please note that Keystone and our Partner Agencies do not accept unsolicited resumes or calls from third-party recruiters or employment agencies. In the absence of a signed Master Service Agreement and approval from HR to submit resumes for a specific requisition, Keystone will not consider or approve payment to any third parties for hires made.