Member Advocate, CVS Health

Position Summary/Mission:

The Member Advocate works alongside other DSNP care team members including social workers, care managers and care coordinators to provide the best member experience.

Fundamental Components

• Educates and assists members on various elements of Medicaid benefits and services , benefit plan information and available services created to enhance the overall member experience with the company. Utilizes all relevant information to effectively influence member engagement.
• Initiates contact with members who have lost their Medicaid eligibility and fall into the DSNP grace period, to remind them to follow through with their Medicaid and LIS recertification. Assists members with finding resources to help them reapply if necessary.
• Coordinates and sends annual reminders for members at risk of losing LIS, Medicaid, or DSNP eligibility.
• Takes ownership of each customer contact to anticipate customer needs, resolve their issues and connect them with additional services as appropriate.
• Tracks member s Medicaid certification and eligibility dates and MCO plan information, as well as Medicaid status.
• Researches other general Medicaid programs, benefits and services the members are eligible for and initiate process to inform members of these benefits.
• Completes accurate case documentation as needed.
• Works with National DSNP Program Office Medicaid Policy Manager and State Contract Manager to provide general assistance with Medicaid benefits and entitlements.

Required Qualifications

• Knowledge of Medicaid benefits, services, program and system design (Health and Welfare, Wealth, other benefits), legal/regulatory requirements.
• Knowledge and understanding of state policy or Medicaid eligibility and low-income state resources.
• Strong collaboration skills and innovative problem-solving abilities.
• Strong verbal and written communication skills
• Ability to work independently, accurately, and efficiently
• Innovative Thinking and Change Agent – Looks for, identifies and acts on opportunities to improve how we design, develop, and deliver products and services.
• Empathy towards customers needs and concerns.

Preferred Qualifications

• Please see requirements above

Education

• Associate s degree or equivalent work experience

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