Member Retention Advocate

Performs outreach to identified new and existing members to help navigate positive experiences with the Health Plan and ensure member satisfaction to minimize rapid disenrollments. Advocates will assist by resolving escalations and complex issues and eliminate service interruptions to retain members. Works under moderate supervision.

• Conduct outbound calls to ensure members are satisfied with their current services, understand their benefits and aid with issues as needed.
• Ensures new members understand plan details and options they are eligible for, answers inquiries related to all VNS Health plans products, and records resulting actions and comments.
• Collaborate with Health Plan teams to resolve member issues and immediately address member dissatisfaction to reduce disenrollment rates.
• Captures relevant data to address negative experiences and share with sales, product team and business owners.
• Provides interaction details to Health Plan product and quality teams to address process enhancements and follow up opportunities to achieve high STARS ratings.
• Refers unresolved escalated inquiries to Manager, Sales team or appropriate Health Plan departments.
• Performs all duties within CMS guidelines, following all rules and regulations and stays up to date on all new marketing policies.
• Develops and maintains knowledge of products, services and systems as required.
• Participates in special projects and performs other duties as assigned.

Education:

• Bachelor's Degree in health/human services, healthcare or business administration or related field or equivalent work experience required.

Work Experience:

• Three to five years of experience working with customers in customer service or in a medical or managed care environment.
• Experience communicating directly with customers & assessing needs.
• Ability to demonstrate excellent service knowledge & hospitality.
• Must display optimistic warmth and empathy for the customers’ experience.
• Ability to quickly learn and navigate different information technology systems.
• Excellent verbal and written communication skills, required.
• Bi-lingual skills, preferred.