Member Advocate III supporting healthcare navigation for L.A. Care Health Plan members. Handling complex cases, resolving issues, and facilitating access to services for vulnerable populations in Los Angeles.
Responsibilities
Advocates and assists members in navigating their health plan benefits, accessing care, resolving issues, addressing waste and abuse, and connecting to community, clinical, and social services
Handles complex, sensitive, or escalated cases
Provides guidance to other advocates
Collaborates across departments to improve the member experience
Conducts high-touch outreach to support vulnerable or high-risk populations, including seniors, individuals with chronic conditions, and members with unmet social needs
Serves as a subject matter expert for benefit interpretation, care coordination pathways, and service workflows
Resolves escalated inquiries from customer service, care management, and provider relations
Connects members to community resources related to housing, food, transportation, financial assistance, behavioral health, and other social determinants of health (SDoH) needs
Supports member engagement initiatives such as health literacy outreach, preventive care reminders, redetermination support, and quality-improvement campaigns
Requirements
Associate's Degree (In lieu of degree, equivalent education and/or experience may be considered)
At least 5 years of experience in member services, advocacy, care coordination, customer service, or healthcare navigation
Experience working with vulnerable, underserved, and culturally diverse populations
Experience resolving individual cases with regulatory state agencies
Strong understanding of health plan benefits, medical terminology, and the healthcare delivery system
Excellent communication, problem-solving, and conflict-resolution skills
Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable (English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese)
Knowledge of healthcare regulations and policies and procedures
Proficiency with CRM systems, case management tools, and documentation standards
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