Member Advocate

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

Responsibilities

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

* Once member is enrolled, follow up member to ensure that 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 updates about the
plan;

* Act 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;

* Develop and maintain relationships 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 at least monthly;

* Follow up on any items that the members are dissatisfied with and report to
plan accordingly;

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

* Ensure that ALL interactions with the member are compliant with CMS
regulations;

* The Member Advocate will be responsible for a group of nursing facilities;
the Member Advocate is responsible for 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

* 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.