Senior Member Advocate
Community First Health PlansPOSITION SUMMARY/RESPONSIBILITIES:
Serve as an advocate to assist and/or represent STAR+PLUS members on their behalf,
in navigating the complaint and appeals process and providing education and support to
access necessary services. To include communication via correspondence as needed.
This individual may work closely with the Service Coordination team and may facilitate
mediation in cases of reported complaints regarding service coordination. 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 processes as needed. Ensures compliance with the Health
Insurance Portability and Accountability Act (HIPAA) related policies in regards to all
aspects of operations within Member Services.
EDUCATION/EXPERIENCE
Bachelor’s degree in business, health care or related field with at least two years’
experience in the managed care industry is preferred. Minimum of one years’
experience in the managed care industry may be substituted for college education.
Complaints and appeals resolution or quality improvement management experience is
preferred.
12238 Silicon Drive, San Antonio, TX, United States
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