Lead Member Advocate

Company: Oklahoma Complete Health
Location: Shawnee
Posted on: November 19, 2023

Job Description:

You could be the one who changes everything for our 28 million members as a Customer Care professional at Centene. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Act as an advocate for the Member and a liaison between the Health Plan and Provider(s) to ensure availability and access to care while coordinating the day to day work function of the Community Relations area, acting as a "go to" person for the department. Establish a community presence, promote Member education, identify and resolve any systemic barriers that limit Members access to appropriate 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.
• Resolve complex member issues and act as "go to" person for others in department.
• Serve as primary contact person to receive and register for all health fair and other community outreach events. Responsible to assign coverage for all health fair and other community events, including Baby Shower and Newborn Care & Breastfeeding Class.
• Assist department with tracking and meeting performance standards. --- Assist with updating training material and training new hires.
• Maintain confidentiality per HIPAA guidelines.Education/Experience: High school diploma or equivalent. 2+ years of customer service experience in a managed care or insurance environment. Experience with member complaints. Medicare and/or Medicaid experience preferred. Must be cross trained in another major functional area within the business unit, or have relevant knowledge to handle special projects.
  
  For Oklahoma Complete Health Plan: Should have lived experience as a Health Plan enrollee. Responsible for development and oversight of the Health Plan Enrollee Advisory Board. Position will have expertise with the specialty populations.
  Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
  Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Keywords: Oklahoma Complete Health, Midwest City , Lead Member Advocate, Other , Shawnee, Oklahoma