Member Advocate

POSITION SUMMARY/RESPONSIBILITIES:

Serve as an advocate to assist and/or represent STAR, STAR Kids, CHIP, Medicare Advantage, and Commercial members in navigating benefits, services, complaint and complaint appeals processes and provide education and support to access care and services. To include communication via written correspondence and secure email, as needed. They may also assist the member in accessing non-covered services, such as those provided in other social service or community programs. Additionally, they may be called upon to participate in other interdepartmental processes, as needed. Ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA) related policies in regard to all aspects of operations within Member Services. This individual may work closely with the Service Coordination and Care Management team and may facilitate mediation in cases of reported complaints regarding service coordination and care management. Provide information to the appeal panels, employer groups and/or regulatory agencies when appropriate. Assist in training regarding the Complaint and Appeal process. 

EDUCATION/EXPERIENCE

Bachelor’s degree in business, health care or related field with at least two years’ experience in the managed care industry is required.  Minimum of five years’ experience in the managed care industry may be substituted for college education.  Complaints and appeals resolution or quality improvement management experience is preferred.