Member Advocate Resume Samples

The Member Advocate assists the Company or Facility’s members based on the mental and health care needs of the patient. While the actual duties differ based on the type of the provider or organization, the following are certain core tasks seen on the Member Advocate Resume – identifying service options for members, gathering information for the service approval, receiving incoming calls from members and providers; prioritizing and scheduling appointments based on the urgency of the members; collecting clinical and treatment information from providers; complying with established standards, and researching and gathering information to prepare cases.

Summary of skills commonly expected on the resumes includes – demonstrable intermediary computer skills; strong communication skills; knowledge of medical terminologies, confidence in learning new systems and databases and strong customer service skills. A degree is the minimum education requirement.

Member Advocate Resume example

Member Advocate Resume

Objective : Over 15 years of experience working for the State of Indiana with families, children, and individuals with disabilities. Knowledgeable of various government programs including Medicaid, TANF, Food Stamps, and IMPACT.

Skills : Management, Organizing.

Description :

    1. Responsible the Hoosier Care Connect program and is responsible for representation of members' interests including input in policy development, planning, and decision-making.
    2. Responsible for doing 3 presentations per quarter for a community organization that works with the aged, blind disabled (ABD) population.
    3. Requires to be a part of at least 4 community coalitions /committees that advocate for the ABD population and attend the meetings regularly (monthly or quarterly).
    4. Requires to establish and maintain 3 new community partner relationships.
    5. Requires to plan and coordinate 1 Member Advisory Council Meeting (MAC) for Hoosier Care Connect Members per quarter.
    6. Respondents shall describe their proposed methods to facilitate member participation, for example, providing transportation, interpretation services, or personal care assistance.
    7. Provides benefit information Advise member of appropriate CO pays or costs of prescriptions or medical services Schedule appointments for the member.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
BS


Sr. Member Advocate Resume

Summary : To obtain a position where skills and experience can be effectively utilized as well as challenged by new learning opportunities that are available.

Skills : Microsoft Office, Management.

Description :

    1. Served as an advocate for the member and liaison between the health plan and providers to ensure availability and access to care.
    2. Established a community presence, promote member education, identify and resolve any systemic barriers that limit member's access to appropriate care.
    3. Researched claims, authorizations and referrals for plan members to ensure correct claim payments and physician approvals.
    4. Resolved plan members and providers escalated complaints in a timely manner to help regain confidence in company services.
    5. Coordinated the delivery of member handbooks, provider directories, and any other educational material to plan members as necessary.
    6. Performed business analysis for Medicare Application Processing in SalesForce.
    7. Analyzed, track and reported data from daily submissions between enrollment and efficiency reports for accuracy of compensation and any discrepancies of applications for the accuracy of final compensation of eligibility.
    8. Implemented a tracking and color-coded map of the health plans new counties and zip codes.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Associate's


Jr. Member Advocate Resume

Objective : To obtain a Member Advocate position, where will contribute to teamwork in an effective and efficient environment for quality patient care.

Skills : Microsoft Office, HTML, XHTML.

Description :

    1. Performs HEDIS measures.
    2. Communicates with members of the health plan.
    3. Books and makes appointments for Care gaps( Well annual visits, Dental annual visits, immunizations, Breast cancer screening, Retinal eye exams, Colorectal Cancer screenings, etc.), book transportation, coordinate Case management if needed.
    4. Provides customer service to providers, Process prior authorizations needed based on Medical necessity.
    5. Works with PCP's to redirect patient to see participating provider within Sunshine Health.
    6. Works with Case Management when patient is in need of services other than medical treatment.
    7. Faxes info to providers regarding whether or not more info is needed or when the authorization has been approved, work with member services with assisting patient's questions and inquiries.
    8. Basically provides any type of service that can and will benefit the member /patient.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Diploma

Member Advocate I Resume

Objective : To find employment with a company that will utilize experience and knowledge and can become a future career.

Skills : Management, Organizing.

Description :

    1. Collaborated with all internal departments to coordinate and insure access to and delivery of care of Medicaid/CHIP members that included children with special needs and other underserved groups.
    2. Educated and assisted members on benefits, claims issues, medical transportation, complaints, grievances and appeals.
    3. Participated in outreach events, to form partnerships with community-based organizations to better serve Delta's members.
    4. And Responsibilities: A thorough understanding of member eligibility benefits and claims.
    5. Managed the day-to-day monitoring and management of members.
    6. Attended meetings to represent Delta Dental at quarterly HHSC, Region Nine Health Advisory, as well as other meetings in the region.
    7. Facilitated general oral health education meetings for area Head Starts, local schools and organizations.
    8. Resolved all escalated complaints that came from HHSC for Texas.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Generals

Member Advocate II Resume

Headline : Dedicated Customer Service Representative who provides exceptional customer service through active listening and problem solving. Call Center Representative with expertise providing customer support in high call volume environments. Exceptional computer aptitude and telephone etiquette.

Skills : Microsoft Excel, Microsoft Word.

Description :

    1. Effectively managed a high-volume of inbound and outbound customer calls.
    2. Answered a constant flow of customer calls with up to ten calls in queue per minute.
    3. Addressed and resolved customer product complaints empathetically and professionally.
    4. Gathered and verified all required customer information for tracking purposes.
    5. Accurately documented, researched and resolved customer service issues.
    6. Managed customer calls effectively and efficiently in a complex, fast-paced and challenging call center environment.
    7. Referred unresolved customer grievances to designated departments for further investigation.
    8. Managed high call volume with tact and professionalism.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Diploma

Member Advocate III Resume

Summary : Seeking a challenging Member Advocate position with opportunities to learn new skills and hone current ones.

Skills : Microsoft Office, Customer Service, Hospitality, People Management.

Description :

    1. Worked inquiries via web and telephone helping customer's understand their healthcare insurance benefits and claims.
    2. Acted as a concierge assisting customers with transferring medical records, setting appointments, and locating providers.
    3. Prepared claim adjustments for services that were processed incorrectly.
    4. Recognized for outstanding customer service going above and beyond the normal customer service representative.
    5. Over exceeded production and met numbers that were required for the position.
    6. Assisted with new trainees' questions and concerns.
    7. Used Advanced level computer skills utilized daily.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
MBA

Asst. Member Advocate Resume

Objective : Competent business professional seeking part-time employment, offering strong writing and communication skills, as well as, proficiency with Microsoft Office programs. Organized planner and problem solver who readily adapts to change, works independently and cooperatively on a team to exceed expectations. Able to juggle multiple priorities and meet tight deadlines without compromising quality.

Skills : See Additional Information.

Description :

    1. Assists with triaging, building and resolving appeal and grievance cases.
    2. Conducts critical analysis of highly complex and sensitive member and provider appeals, inquiries and grievances.
    3. Applies internal policies and procedures, contractual provisions, and regulatory requirements when resolving cases.
    4. Maintains tracking database information for caseload and submits trending reports to Director and other departments.
    5. Identifies required changes to policies and procedures based on case resolutions, statutory or regulatory changes, or accreditation requirements.
    6. Proposes changes to management based on identification and analysis.
    7. Evaluates and monitors the work performance of staff and report progress, barriers, and solutions to Director.
    8. Trains and mentors team members on policies and procedures relating to regulatory and accreditation requirements.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Bachelor's

Associate Member Advocate Resume

Summary : To obtain a position in an organization where skills and abilities are put to the challenge.

Skills : Management, Organizing.

Description :

    1. Performs as an advocate on behalf of the Children's Community Health Plan members.
    2. Facilitates the timely provision of Badger care plus benefits to CCHP members.
    3. Ensures access to all medically necessary services for CCHP members Make recommendations to CCHP management regarding any changes that were needed to improve access.
    4. Coordinates professional development workshops to increase staff knowledge of community needs.
    5. Fosters and develops community partner relationships and networks Attend various community events and meetings in order to represent CCHP and train staff and members Complete case management for members as needed.
    6. Participates in community projects as a partner, representing CCHP Implement best practices and procedures; assist with creation of literature for members.
    7. Creates PowerPoint presentation for Children's Community Health plan for an overview of programs and services.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
Bachelor's

Lead Member Advocate Resume

Summary : Advocate to provide communications support and advocacy to grassroots campaigns fighting to eliminate the criminalization of Black and Brown youth and create schools and communities that are reflective of the world youth envision for themselves.

Skills : Management, Organizing.

Description :

  • Effectively solves customer inquiries by phone, SMS and email using a CRM tool
  • Holds a high bar for Support when managing customer interactions
  • Identifies, documents and follow up with engineers on product bugs and features
  • Advocates for customers by identifying trends in issues and suggesting improvements to policies and products
  • Recognizes errors and draft improvements to content in the external Support Center and internal documentation
  • Works with members of other teams to root out answers and be a resource to teammates
  • Reports to a Customer Success Lead
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
GED

Member Advocate Resume

Headline : Research and litigation to organizing and communications, and utilizes all mechanisms for supporting those communities, including movement lawyering strategies.

Skills : MS Office, Management.

Description :

    1. Educates Member on the role of Regal Medical Group and Advocate Program.
    2. Introduces member to case management and care team Provide service recovery by facilitating member's needs by working directly with appropriate staff.
    3. Presents and reviews pertinent health related information with member, including post-discharge instructions, urgent care referrals, and welcome information for new members.
    4. Assists assigned members with post-discharge needs.
    5. Assists patients with various appointments and scheduling.
    6. Maintains routine communications with members providing timely follow-up to ensure resolution of issues.
    7. Provides an accurate capture of health information while in the member's home and provides clear and effective documentation of all visits to the Interdisciplinary Care Team.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Bachelors