Position Purpose: Act as an advocate for the Member 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 Members 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.
Investigate and resolve access and cultural sensitivity issues identified by Member Services staff, State staff, providers, advocacy organizations and recipients.
Participate in local community organizations to acquire knowledge and insight regarding the special health care needs of Members and update and revise educational materials as appropriate.
Serve as primary contact for Member advocacy groups, human services agencies and the State entities.
Maintain confidentiality per HIPAA guidelines.
Education/Experience: High school diploma or equivalent. 3 years of customer service experience in a healthcare environment. Medicare and/or Medicaid experience preferred.
For Superior Health Plan - Bilingual in Spanish required.
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.