Member Advocate

Location:

Calmont Operations Building

Department:

Member Services

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

The Member Advocate will serve as a Liaison between the Members and Cook Children's Health Plan (CCHP). 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 CCHP team members involved in the delivery of care to our Members. The Member Advocate will serve as expert in community resources most frequently needed by CCHP Members and finding hard to reach members.

Additional Information:

The Member Advocate will serve as a Liaison between the Members and Cook Children's Health Plan (CCHP). 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 CCHP team members involved in the delivery of care to our Members. The Member Advocate will serve as expert in community resources most frequently needed by CCHP Members and finding hard to reach members.

Education and Experience:

• High School Diploma or Equivalent required

• Bilingual (English/Spanish) required. Must pass Spanish test 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.

Licensure, Registration, and/or Certification:

• Community Health Worker certification required to obtain within 1 year of hire

• Valid Driver's License required.

Knowledge, Skills & Abilities

• Knowledge of state Managed Care Programs (Medicaid, CHIP/CHIP Perinatal) including healthcare advocacy required.

• Excellent oral and written communication skills a must as will be required to draft member educational materials.

• Must be able to handle multiple tasks at once and maintain organization.

• Prioritizing and time management skills are a must. Must be flexible and comfortable working in an environment that includes constant change to program requirements.

• 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, prioritize and track outstanding work while acknowledging that all CCHP Members are the number one priority.

• Efficient in Microsoft Office (Word, Excel, Access, Outlook, PowerPoint) including the ability to document quickly and accurately in between calls.

About Us:

Cook Children's Health Plan

Cook Children's Health Plan provides vital coverage to nearly 120,000 people in low-income families who qualify for government-sponsored programs in our six county service region. Cook Children's Health Plan provides health coverage for CHIP, CHIP Perinatal, STAR (Medicaid) and STAR Kids Members in the Tarrant county service area. The counties we serve includes Tarrant, Johnson, Denton, Parker, Hood and Wise.

Cook Children’s is an equal opportunity employer. As such, Cook Children’s offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.