Member Advocate Manager
Blue Cross Blue Shield Kansas

The Member Advocate Manager is responsible for leading a team of licensed social workers acting as Member Advocates for Blue Cross and Blue Shield of Kansas (BCBSKS). This role focuses on ensuring that members receive high-quality, compassionate assistance with navigating their healthcare benefits, services, and overall experience. The Member Advocate Manager will oversee the team's daily operations, implement best practices, and work closely with internal departments to resolve member issues, enhance satisfaction, and improve the overall member experience. This position requires strategic leadership, relationship building, and ensuring the team is fully equipped to handle a range of member issues, all while improving BCBSKS's service delivery and fostering partnerships with community stakeholders. The role is designed to improve the member experience by managing a mobile, roving team that provides direct, in-person support to BCBSKS members across the state of Kansas, helping them make informed decisions about their care and coverage.

"This position is eligible to work onsite, remote or hybrid (9 or more days a month on site) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment."

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us?

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
  
• Lead and Inspire: Guide and mentor your team to achieve their full potential and success.
  
• Family Comes First: Total rewards package that promotes the idea of family first for all employees.
  
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
  
• Trust: Work for one of the most trusted companies in Kansas
  
• Stability: 80 years of commitment, compassion and community
  
• Flexibility: options to work onsite, hybrid or remote available
  
• Inclusive Work Environment: We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected.
  
  

Compensation

$96,800 - $115,000 annually

Exempt 17

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.
  

What you'll do

• Lead, coach, and mentor a team of member advocates to ensure they provide effective, empathetic, and knowledgeable support to members.
  
• Conduct regular team meetings, performance evaluations, and one-on-one coaching sessions to develop the team's skills and address any performance concerns.
  
• Develop and implement training programs for new and existing team members to ensure they are up to date on healthcare benefits, policies, and effective communication techniques.
  
• Monitor team performance and set clear goals, KPIs, and metrics to ensure high-quality member service.
  
• Oversee the resolution of member inquiries, complaints, and concerns in a timely and professional manner, ensuring a high level of member satisfaction.
  
• Assist members in understanding their healthcare benefits, eligibility, coverage options, and claim processes.
  
• Provide guidance on complex issues such as claim disputes, pre-authorizations, network issues, and service availability, advocating on behalf of members where necessary.
  
• Serve as the escalation point for more complicated member issues that require advanced problem-solving or management intervention.
  
• Collaborate with internal departments, such as Customer Service, Claims, Utilization Management, and Healthcare Providers, to ensure a seamless and coordinated experience for members.
  
• Work closely with other departments to address recurring member concerns and identify opportunities to improve services and processes.
  
• Represent the voice of the members in meetings and discussions about policy changes, system improvements, and service offerings.
  
• Analyze trends in member inquiries, complaints, and feedback to identify areas for process improvement and enhance the member experience.
  
• Develop strategies and action plans to address systemic issues that affect member satisfaction.
  
• Compile and present regular reports on team performance, member satisfaction, and issue resolution to senior management.
  
• Implement and monitor quality assurance measures to ensure that the team meets established service standards and goals.
  
• Ensure that the team adheres to all relevant healthcare regulations, privacy laws (such as HIPAA), and organizational policies when interacting with members and handling sensitive information.
  
• Keep up to date on regulatory changes affecting healthcare services and benefits to ensure accurate, compliant member assistance.
  
• Ensure that all member interactions are documented accurately and in compliance with organizational standards.
  
• Develop resources and materials to educate members on available benefits, healthcare services, and how to navigate the healthcare system effectively.
  
• Encourage and empower members to take an active role in managing their health and utilizing available services.
  
• Actively seek and encourage member feedback through surveys, direct communication, and other channels to understand their experiences and satisfaction levels.
  
• Use member feedback to drive continuous improvement initiatives within the member services function.
  
• Establish and maintain a positive relationship with members, fostering trust and loyalty.
  

What you need
Knowledge, Skills, and Abilities

• In-depth understanding and knowledge of various healthcare plans, healthcare systems, community resources, benefits, eligibility requirements, and coverage options, including commercial, Medicaid, and Medicare plans.
  
• Strong knowledge of healthcare laws and regulations (e.g., HIPAA, Affordable Care Act), ensuring compliance with privacy and security standards.
  
• Familiarity with the healthcare claims process, including claim adjudication, pre-authorizations, appeals, and denials.
  
• Comprehensive understanding of customer service best practices and member engagement techniques in a healthcare setting.
  
• Knowledge of member satisfaction metrics, feedback mechanisms, and using data to improve member services and program effectiveness.
  
• Proven ability to lead, motivate, and develop a team of member advocates, ensuring high performance, morale, and professional growth.
  
• Excellent verbal and written communication skills, with the ability to clearly explain complex healthcare topics to members and a diverse range of stakeholders.
  
• Strong critical thinking and decision-making skills, particularly in resolving complex or sensitive issues related to member concerns, claims disputes, or service access.
  
• Strong problem-solving abilities, with a demonstrated capacity for addressing complex healthcare issues and financial concerns.
  
• Ability to analyze data from member interactions, identify trends, and develop strategies to improve service delivery, member satisfaction, and operational efficiency.
  
• Capable of managing multiple tasks and priorities effectively in a fast-paced environment, ensuring urgent issues are addressed promptly while maintaining routine operations.
  
• Ability to empathize with members, listen actively, and respond with care and concern, providing a high level of service and support during challenging situations.
  
• Ability to work effectively with cross-functional teams (e.g., Claims, Customer Service, Healthcare Providers) to resolve member issues and improve overall service delivery.
  
• Ability to quickly adapt to changes in healthcare policies, organizational goals, and member needs, maintaining flexibility in service delivery.
  
• Ability to make informed, timely decisions that balance member needs, organizational goals, and compliance requirements.
  
• Ability to manage and resolve conflicts, both with members and within the team, using diplomacy and negotiation skills to reach solutions that are in the best interest of the organization and the members.
  
• Ability to educate and empower members by clearly explaining their rights, benefits, and available resources, while advocating on their behalf when necessary.
  
• Ability to lead a team in a flexible, mobile environment, balancing day-to-day operations with long-term strategic goals.
  
• Proficiency in technology platforms for scheduling, reporting, and member management.
  
• Proficiency in customer service software, CRM systems, and Microsoft Office Suite.
  
• Valid driver's license must be attained for the position.
  
  

Education and Experience

• Bachelor's degree in healthcare administration, business administration, public health, nursing, social work, health services management or a related field required.
  
• Master's degree in social work (MSW) required.
  
• Licensed to practice Social Work in the state of Kansas.
  
• Minimum of 5 years of experience in healthcare, social work, case management, care coordinator or a related field, with a focus on insurance benefits and member advocacy.
  
• Minimum of 2 years in a supervisory or team leadership role managing a geographically dispersed team.
  
• Advanced degree or professional certification in patient advocacy, health insurance management, case management preferred.
  
• Demonstrated experience in community outreach, relationship-building with healthcare providers, and addressing member issues in a healthcare setting.
  
  

Physical Requirements

• Primarily office-based, hybrid work or remote, depending on the organization's policies.
  
• Some travel may be required for meetings, training, or member outreach activities.
  
• Flexible work hours may be necessary to accommodate team needs and member inquiries.
  
• This position requires frequent travel throughout the state of Kansas, as Member Advocates will visit members in various settings including provider offices, hospitals, employer groups, and community events. The role demands adaptability, a passion for member advocacy, and the ability to foster positive relationships across diverse environments.
  
  

Benefits & Perks

• Base pay is only one component of your competitive Total Rewards package
  
• Incentive pay program (EPIP)
  
• Health/Vision/Dental insurance
  
• 6 weeks paid parental leave for new mothers and fathers
  
• Fertility/Adoption assistance
  
• 2 weeks paid caregiver leave
  
• 5% 401(k) plan matching
  
• Tuition reimbursement
  
• Health & fitness benefits, discounts and resources
  

Our Commitment to Diversity, Equity, Inclusion, and Belonging

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of diversity, equity, inclusion, and belonging (DEIB), where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.

We believe that embracing diversity and authentically promoting inclusion, equity, and belonging among our team members is crucial to our collective success. By intentionally recruiting, developing, and retaining a diverse pool of talent, we cultivate an environment where everyone feels valued, heard, and empowered to contribute. Accommodations are available for applicants with disabilities upon request, ensuring an inclusive and accessible hiring process for all.

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