JOB SUMMARY: A Member Advocate represents and advocates for the best interests of Community members, serving essentially as the voice of our members within the Community's organization. The Member Advocate is responsible for advocating for the Member and serving as a liaison between the Health Plan and Provider(s) to ensure availability and access to care. Member Advocates will establish a community presence, promote and conduct member education, identify and resolve any general barriers that limit member's access to appropriate care. Receive and respond to Member complaints and formal grievances and identify potential access to care or service and assist the member in the grievance procedure. Member Advocates will participate in local community organizations to acquire knowledge and insight regarding the special health care needs of Members and recommend updates and revisions to educational materials as appropriate. They will serve as primary contact for Member advocacy groups, human services agencies and the State entities. Their role will include educating members of their rights and responsibilities as a health plan member and shall maintain confidentiality per HIPAA guidelines at all times.
1.Education/Specialized Training/Licensure:High School Graduate or equivalency required
2.Work Experience (Years and Area):One (1) Year Customer Service Experience in Health Care/Plans.
Face to Face Customer Service Experience is a plus but not required.
Knowledge of Medicaid, CHIP, Medicare Advantage and Market place preferred.
Bilingual Skills Required? Languages:
Writing /Composing, Correspondence / Reports
Ability to work independently and to build community relationships.
Knowledge of medical terminology