Member Advocate I

Member Advocate I

Requirements

• High school diploma or equivalent
• 3+ years of customer service experience in a healthcare environment
• Medicare and/or Medicaid experience preferred

Responsibilities

• Act as an advocate for the Member and a liaison between the Health Plan and Provider(s) to ensure availability and access to care
• Receive and respond to Member complaints and formal grievances and identify potential access barriers and resolve as indicated in the grievance procedure
• Investigate and resolve access and cultural sensitivity issues identified by Member Services staff, State staff, providers, advocacy organizations and recipients
• Participate in local community organizations to acquire knowledge and insight regarding the special health care needs of Members and update and revise educational materials as appropriate
• Serve as primary contact for Member advocacy groups, human services agencies and the State entities
• Maintain confidentiality per HIPAA guidelines

Preferred Qualifications

• Medicare and/or Medicaid experience preferred