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.
Objective : A dedicated Member Advocate with two years of experience in fostering member relationships and enhancing community engagement. Skilled in delivering tailored support, facilitating effective communication, and advocating for member needs in various settings. Committed to improving member outcomes and ensuring access to vital services while promoting a collaborative environment.
Skills : Community Engagement, Problem Solving, Conflict Resolution, Active Listening
Description :
Oversee the Hoosier Care Connect program, advocating for member interests in policy development and decision-making.
Conduct three presentations per quarter for community organizations focused on the aged, blind, and disabled (ABD) population.
Participate in at least four community coalitions to advocate for ABD members, attending meetings monthly or quarterly.
Establish and nurture three new community partnerships to enhance member support.
Plan and coordinate quarterly Member Advisory Council meetings for Hoosier Care Connect members.
Facilitate member participation through transportation and interpretation services as needed.
Provide comprehensive benefit information, advising members on co-pays and scheduling appointments.
Experience
0-2 Years
Level
Entry Level
Education
B.S. Health Admin.
Senior Member Advocate Resume
Headline : Dynamic Senior Member Advocate with 7 years of experience in enhancing member satisfaction and ensuring access to essential services. Proven ability to build strong member relationships, resolve complex issues, and streamline communication between stakeholders. Passionate about driving positive outcomes and fostering a supportive community for all members.
Skills : Proficient In Microsoft Office Suite, Multitasking, Critical Thinking, Negotiation Skills, Technical Proficiency
Description :
Acted as a primary advocate for members, facilitating communication between health plans and providers to ensure timely access to care.
Enhanced community presence through member education initiatives, identifying and addressing systemic barriers to care.
Conducted thorough research on claims and authorizations, ensuring accurate payments and approvals for members.
Resolved escalated complaints from members and providers efficiently, reinforcing confidence in company services.
Coordinated distribution of member handbooks and educational materials, improving member understanding of available services.
Performed data analysis on Medicare Application Processing using Salesforce to enhance operational efficiency.
Tracked and reported on enrollment data, ensuring accuracy in compensation and eligibility assessments.
Experience
5-7 Years
Level
Senior
Education
B.S. Health Admin.
Member Advocate Resume
Objective : Enthusiastic Member Advocate with two years of experience in enhancing member satisfaction and engagement. Adept at delivering personalized support, resolving issues, and facilitating clear communication to meet member needs. Passionate about fostering relationships and advocating for access to essential services, ensuring a positive experience for all members.
Conducts HEDIS measures to ensure compliance and quality care.
Books appointments for annual wellness visits and preventive services, coordinating transportation and case management as needed.
Provides exceptional customer service to healthcare providers, processing prior authorizations based on medical necessity.
Collaborates with primary care providers to guide patients to in-network specialists.
Partners with case management to address non-medical needs of members.
Communicates with providers to confirm authorization status and additional information requirements.
Delivers comprehensive member services to enhance patient experience and outcomes.
Experience
0-2 Years
Level
Junior
Education
BA Comm
Associate Member Advocate Resume
Objective : Driven Associate Member Advocate with two years of experience in strengthening member relations and enhancing service access. Proficient in providing personalized support and effective communication to address member needs. Eager to leverage skills to improve member satisfaction and promote community engagement, ensuring a seamless experience for all stakeholders.
Skills : Organizational Skills, Policy Knowledge, Data Entry, Time Management, Team Collaboration, Adaptability
Description :
Collaborated with internal departments to ensure seamless care delivery for Medicaid and CHIP members, focusing on underserved populations.
Educated members on benefits, claims, and services to enhance their understanding and access.
Participated in community outreach events to forge partnerships with local organizations.
Monitored member eligibility and managed claims processes to ensure compliance.
Represented the organization at regional health advisory meetings to advocate for member needs.
Facilitated oral health education sessions in local schools and community organizations.
Resolved escalated complaints from members, ensuring timely and effective solutions.
Experience
0-2 Years
Level
Entry Level
Education
B.A.
Member Advocate Resume
Objective : Dedicated Member Advocate with over 5 years of experience in customer service and support. Skilled in resolving member inquiries, enhancing member satisfaction, and promoting engagement. Proven ability to communicate effectively and build strong relationships with diverse populations. Committed to advocating for member needs and ensuring a positive experience within the organization.
Skills : Data Analysis, Client Relationship, Service Orientation, Phone Etiquette, Training Skills, Quality Assurance
Description :
Effectively managed a high volume of inbound and outbound member communications.
Responded to member inquiries with a focus on resolving issues promptly and empathetically.
Documented and tracked member interactions to enhance service delivery and follow-up.
Collaborated with cross-functional teams to address member needs and streamline service processes.
Conducted surveys to gather member feedback and identified areas for improvement.
Facilitated workshops and information sessions to educate members about available services.
Analyzed member data to identify trends and improve engagement strategies.
Experience
2-5 Years
Level
Junior
Education
B.A. Comm.
Advanced Member Advocate Resume
Headline : With 7 years of experience as a Member Advocate, I excel in optimizing member experiences and support services. My expertise lies in building strong relationships, resolving complex issues, and advocating for member needs effectively. I am dedicated to enhancing community engagement and ensuring access to essential resources, driving positive outcomes for all members.
Skills : Advanced Microsoft Office Skills, Customer Service Excellence, Attention To Detail, Customer Advocacy
Description :
Managed inquiries via web and telephone, assisting customers with understanding healthcare insurance benefits and claims.
Facilitated medical record transfers, appointment scheduling, and provider location for members.
Processed claim adjustments for mismanaged services, ensuring accurate member billing.
Recognized for delivering exceptional customer service, consistently exceeding performance metrics.
Surpassed production targets, contributing to overall team success and efficiency.
Provided guidance to new trainees, addressing their questions and concerns effectively.
Utilized advanced computer skills to enhance operational workflows and member interactions.
Experience
5-7 Years
Level
Senior
Education
B.S. in HA
Member Advocate Resume
Objective : Passionate Member Advocate with two years of experience dedicated to enhancing member services and satisfaction. Proficient in resolving inquiries, improving communication, and ensuring access to essential resources. Committed to fostering strong relationships within the community while advocating for member needs and driving positive outcomes.
Skills : Follow-up Skills, Research Skills, Customer Retention, Analytical Skills, Feedback Management, Case Management
Description :
Facilitate communication between members and the organization to enhance satisfaction.
Resolve member inquiries and issues promptly and effectively.
Educate members on available services and benefits.
Maintained tracking database information for caseload and submitted trending reports to management.
Identified necessary changes to policies based on case resolutions and regulatory updates.
Proposed actionable changes to management based on analysis of case data.
Evaluated staff performance and reported progress and solutions to management.
Experience
0-2 Years
Level
Entry Level
Education
B.S. Health Admin
Assistant Member Advocate Resume
Objective : Results-driven Member Advocate with a strong background in healthcare services. Expertise in addressing member concerns, providing information on benefits, and facilitating access to resources. Adept at using CRM systems to track interactions and improve service delivery. Passionate about empowering members and fostering a supportive community environment.
Skills : Customer Service, Presentation Skills, Empathy, Resource Management, Cultural Competence, Communication Skills
Description :
Advocate for Children's Community Health Plan members, ensuring timely access to necessary services.
Facilitate the provision of Badger Care Plus benefits, improving member utilization.
Assess and recommend improvements to access issues, collaborating with management for effective solutions.
Coordinate professional development workshops, enhancing staff knowledge of community resources.
Build and maintain relationships with community partners, representing CCHP at various events.
Participate in community projects, implementing best practices for member engagement.
Create informative presentations on programs and services for member education.
Experience
2-5 Years
Level
Junior
Education
B.S. Health Admin.
Member Advocate Resume
Summary : Bringing a decade of experience as a Member Advocate, I excel in building robust member relationships and enhancing service accessibility. My expertise includes resolving complex issues, advocating for member needs, and facilitating effective communication across diverse platforms. I am dedicated to fostering a supportive environment that empowers members and drives positive community outcomes.
Skills : Sales Skills, Report Writing, Social Media Skills, Networking Skills, Time Zone Awareness, Cultural Sensitivity
Description :
Effectively resolves member inquiries via phone, SMS, and email using CRM tools.
Maintains high standards of support while managing member interactions.
Documents product bugs and collaborates with engineering teams for resolution.
Identifies trends in member issues and advocates for policy improvements.
Enhances content quality in the Support Center and internal documentation.
Collaborates with cross-functional teams to provide comprehensive support.
Reports insights and recommendations to the Customer Success Lead.
Experience
7-10 Years
Level
Management
Education
B.A.
Member Advocate Resume
Objective : Motivated Member Advocate with two years of experience in enhancing member relationships and improving service accessibility. Demonstrates expertise in providing personalized support, resolving inquiries, and promoting effective communication to meet member needs. Passionate about fostering a collaborative environment that empowers members and drives positive outcomes.
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