Centene Corporation Member Advocate II - Dedham, MA in Boston, Massachusetts
You could be the one who changes everything for our 26 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 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.
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.
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.
TITLE: Member Advocate II - Dedham, MA
LOCATION: Various, Massachusetts
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