Job Description

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

* Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

* Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

* Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

* Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Skills / Requirements

JOB SUMMARY: A Member Advocate represents and advocates for the best interests of Community members, serving essentially as the voice of our members within the Community's organization. The Member Advocate is responsible for advocating for the Member and serving as a liaison between the Health Plan and Provider(s) to ensure availability and access to care. Member Advocates will establish a community presence, promote and conduct member education, identify and resolve any general barriers that limit member's access to appropriate care. Receive and respond to Member complaints and formal grievances and identify potential access to care or service and assist the member in the grievance procedure. Member Advocates will participate in local community organizations to acquire knowledge and insight regarding the special health care needs of Members and recommend updates and revisions to educational materials as appropriate. They will serve as primary contact for Member advocacy groups, human services agencies and the State entities. Their role will include educating members of their rights and responsibilities as a health plan member and shall maintain confidentiality per HIPAA guidelines at all times.

1. Education/Specialized Training/Licensure: High School Graduate or equivalency required
2. Work Experience (Years and Area): One (1) Year Customer Service Experience in Health Care/Plans.
Face to Face Customer Service Experience is a plus but not required.
Knowledge of Medicaid, CHIP, Medicare Advantage and Market place preferred.

1. Communication Skills:
Bilingual Skills Required? Languages:
Writing /Composing, Correspondence / Reports

2. Other Skills:
Ability to work independently and to build community relationships.

Knowledge of medical terminology


Application Instructions

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