Member Advocate II

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.
 

***Hybrid role that will require travel. Candidate must reside in the state of WI, highly preferred that candidate resides within the Milwaukee area.***

Position Purpose: Act as an advocate for members and a liaison between the Health Plan and Provider(s) to ensure availability and access to care. Establish a community presence, promote member education, identify and resolve any systemic barriers that limit 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.
• Serve as primary contact and liaison between member advocacy groups, human services agencies, providers and State entities.
• Evaluate member qualifications for better benefit entitlement programs.
• Conduct field trainings and face-to-face meetings with providers, members and community agencies and report results to senior management for any needed resolutions.
• Recommend changes in internal processes to affect provider and member satisfaction.
• Advise Health Plan on contract compliance in the delivery of covered services.
• Perform training, orientation and coaching for performance improvement within physician practices, community agencies, and health plan.
• Educate members and providers regarding policies and procedures related to benefits, website promotion and education.
• Investigate and resolve access and cultural sensitivity issues identified by internal departments, State staff, providers, advocacy organizations and members.
• Participate in local community coalitions to acquire knowledge and insight regarding the special health care needs of members and update and revise educational materials as appropriate.
• Must have a good driving record and the ability to travel.
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Associate’s degree or equivalent experience. 3+ years of public relations experience. Experience in working with diverse populations. Knowledge of health care, managed care, Medicare or Medicaid. Claims billing/coding knowledge preferred.

License/Certification: Valid driver’s license. Insurance producer license preferred.

Pay Range: $23.23 - $39.61 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act