Member Advocate- full remote Job Vacancy in Texas Children’s Hospital Bellaire, TX 77401 – Latest Jobs in Bellaire, TX 77401 – updated today

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Company Name : Texas Children’s Hospital
Location : Bellaire, TX 77401
Position : Member Advocate- full remote

Job Description : We are searching for a Member Advocate — someone who works well in a fast-paced setting. Investigates resolves and facilitates resolution of simple to moderately complex issues and questions reported by Texas Children’s Health Plan (TCHP) members, prospective members, healthcare providers, or other entities relating to TCHP Managed Care Organization. Acts as the first point of contact for assistance or information regarding eligibility, benefits, authorizations, claims, referrals, and/or any other Member/Provider needs. Assists and advocates for members and providers throughout the complaint and appeal process.
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Responsibilities
Educates members about their rights and responsibilities, which includes the complaints and appeals process
Advocates for members during complaints, appeals, and fear hearings; complies with all necessary information to ensure appropriate Member representation
Solves problems proactively and provides timely resolution to complex issues. Identifies the most appropriate course of action for problem resolution and effectively communicates the plans to those impacted. These issues frequently require research, collaboration with other departments, communications with external resources, and response creation
Responds to internal system trouble notifications and, if necessary, coordinates the involvement of other departments to facilitate problem resolution
Serves as a continual resource for team member questions, concerns, etc.; viewed as being a primary available and approachable resource to team members
Evaluates, monitors, and coordinates community resources
Coordinates with DARS and local resources for the identification and support of employment and training opportunities for members
Identifies options and initiates collaboration with referral sources to ensure member/family linkage to specialists, home care providers, financial assistance, housing, meals, transportation, and other community resources as appropriate for members with unmet needs
Evaluates, monitors, and coordinates community resources and maintains current knowledge of local and state resources
Coordinates with DARS and local resources for the identification and support of employment and training opportunities for members
Identifies options and initiates collaboration with referral sources to ensure member/family linkage to specialists, home care providers, financial assistance, housing, meals, transportation, and other community resources as appropriate for members with unmet need
Assists manager in identifying opportunities for process and service improvement initiatives. Participates in the development and implementation of action plans
Qualifications
H.S. Diploma or GED
2 years’ experience customer service experience within managed care or insurance industry
Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s unless approved for a medical or religious exemption.
Company Profile
Texas Children’s HospitalSince 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S.News & World Reportas well as recognition from Houston Business Journalas one of this city’s Best Places to Work for ten consecutive years.Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, the first hospital devoted to children’s care for communities north of Houston.We have also created the nation’s first HMO for children, established the largest pediatric primary care networkin the country and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.
To join our community of 14,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org. At Texas Children’s Hospital, diversity, equity, and inclusion are at the core of our values and mission for the women and children that we serve. We are committed to providing a diverse and inclusive work environment for all faculty, staff and learners throughout our organization. We believe that each member of our one amazing team provides enrichment that allows us to create a lasting legacy for future employees of this great organization.
Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children’s without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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