Job Description
Lead Member Advocate
locations
Oklahoma City – 14000 N. Quail Springs Pkwy (11117)
Tulsa – 7645 E. 63rd St (11116)
Remote-OK
time type
Full time
job requisition id
1473678
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.
Oklahoma Complete Health, a Centene company, is committed to providing quality healthcare solutions to transform the health of Oklahomans.
At Oklahoma Complete Health, we are community advocates and change-makers in search of an inclusive culture grounded by our commitment to work-life balance, competitive compensation, and continuous career development. Join us and be a part of a collaborative, growing network of innovative thinkers delivering solutions at the local level.
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.