This position is considered a work-from-home position as no formal office space/work location is provided. The Member Advocate conducts majority of their work within Partner nursing homes and Assisted Living Facilities in Member Advocate-specific work region.
The following defines the responsibilities of the Member Advocate in serving our members.
Serve as the main sales and enrollment contact between eligible members or their responsible parties and AgeRight Advantage Health Plan
Serve as the account manager for partner Long-term Care facilities within your territory
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;
Conduct quarterly customer service survey with the member and/or their family; based on the results of the survey, follow up on any items that the members are dissatisfied with;
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;
Serve as a licensed insurance agent to explain plan benefits to potential plan members, answer questions about the plan, and, as needed, aid in member enrollment into the plan during the annual open enrollment period and through continuous enrollment efforts;
Other responsibilities as assigned.
Three or more years of 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;
Currently hold a license to sell health insurance in representative state and be in good standing with the licensing board; or, ability to pass the educational requirements and testing required to obtain the license in your state of residence.
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;