Community Health Worker-Member Advocate
2 months ago
- Weekly Pay with benefit options
- Start ASAP if all qualifications met
Summary:
The Member Advocate will serve as a Liaison between the Members and the Medical Plan. The Member Advocate will help Members and their Legally Authorized Representatives (LARs) navigate through the complexities of the healthcare system. The Member Advocate will guide and educate Members on their benefits, Member Rights & Responsibilities, Complaints and Appeals all while maintaining cultural sensitivity and confidentiality. The Member Advocate will deliver a highly satisfactory customer experience by responding to every inquiry immediately and directly, when possible, or by collaborating with other team members involved in the delivery of care to our Members. The Member Advocate will serve as an expert in community resources most frequently needed by Plan Members and finding hard to reach members
Essential Job Functions:
- Build rapport with Members and their LARs by responding to Member inquiries in a respectful and timely manner following all policies and procedures
- Act as an advocate for the member and a liaison between the Health Plan and to ensure availability and access to health care
- Promote Member education, identify and resolve any systemic barriers that limit Member’s access to appropriate care
- Serve as primary contact for member advocacy groups, human services agencies and the State entities
- Provide Member education regarding Member Rights & Responsibilities, complaints and appeal process, medically necessary covered services, non-capitated services and linguistic services
- Translate educational and healthcare needs and act as a liaison for Members/ LARs
- Participate in local community organizations to acquire knowledge and insight regarding the special health care needs of Members, Community resources available, and update and revise educational materials as appropriate.
- Aid members in establishing and renewing their plan by conducting application and renewal assistance
- Coordinate issue resolution, work with other plan departments as needed to resolve member complaints/grievances and member inquiries ensuring that all information is collected and documented accurately and sent in a timely manner to the Compliance Department
- Receive and respond to member complaints and formal grievances
Qualifications:
- Must be bilingual with fluency in both English and Spanish with excellent oral and written communication skills
- Must pass a Spanish proficiency examination prior to hire
- Must have 1-2 years’ experience in community outreach or Member Advocate services
- Must have 1-2 years' experience working with health insurance in a health plan setting and be knowledgeable of health insurance terminology
- Excellent oral and written communication skills a must as will be required to draft member educational materials
- Prioritizing and time management skills are a must
- Strong problem-solving skills and the ability to make independent decisions including the ability to manage difficult callers and resolve any departmental conflicts that may arise
- Required to work independently as well as within a team environment
- Efficient in Microsoft Office (Word, Excel, Access, Outlook, PowerPoint) including the ability to document quickly and accurately in between calls
- CHW License required upon hire
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