Community Health Advocate

1 month ago

Fort Worth, Texas, United States SUITEMATE STAFFING SOLUTIONS INC Full time
Job Summary

The Member Advocate will serve as a liaison between the Members and the Medical Plan, helping them navigate the complexities of the healthcare system. This role requires excellent communication skills, cultural sensitivity, and the ability to maintain confidentiality.

Key Responsibilities
  • Build rapport with Members and their Legally Authorized Representatives (LARs) by responding to their 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 ensure availability and access to healthcare.
  • 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 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 healthcare 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.
Requirements
  • 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 are 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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