Member Advocate (Oklahoma)

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Business Overview
Aetna Better Health of Oklahoma, a CVS Health company, embodies the vision to be a trusted health partner in the local Oklahoma communities we serve. We provide a full array of innovative services that enhance overall wellness and improve everyday life for our members. At Aetna Better Health of Oklahoma, we value professional development and career growth. You will work alongside colleagues who align on Heart at Work behaviors, bringing your heart to every moment of health. We will support you all the way!Position Summary:
Qualified candidates must reside in Oklahoma. The Member Advocate ensures the voices and experiences of health plan members ("enrollees") are heard by collecting and sharing feedback that informs policy development, planning, and decision-making. This role requires lived experience as a health plan member and is responsible for the development and oversight of the Advisory Committee, as specified by state contract. The Member Advocate also plays an active role in community events, providing education to members and community-based organizations about available benefits and resources. Collaboration with development, data analytics, and training teams is essential to enhance member access to value-added/extra benefits and drive continuous improvement in member experience. In-state travel is required to fulfill duties.Fundamental Components:

• Gather, synthesize, and communicate member feedback to management to inform policy, planning, and decision-making.
• Develop, oversee, and facilitate the Advisory Committee in accordance with state contract requirements (Section 1.12.9), ensuring member perspectives are regularly collected and shared.
• Ensure Advisory Committee feedback is used to guide recommendations for program and service improvements.
• Collaborate with development, data analytics, and training teams to improve member understanding and utilization of value-added/extra benefits.
• Identify and communicate access and cultural sensitivity issues raised by members, colleagues, providers, and advocacy organizations.
• Monitor and analyze trends in grievances and appeals and member disenrollments; provide feedback and insights to management and community advocates.
• Coordinate with schools, community agencies, state agencies, and advocacy groups to collect member input, support member needs, and remove barriers to care.
• Participate in community events to educate members and community-based organizations about health plan benefits, services, and resources.
• Support initiatives that address social determinants of health and promote holistic, coordinated care for all members
• Review and provide input on member-facing materials for clarity and accessibility.
• Performs other related duties and special projects as assigned.
• Maintains availability/willingness to travel to various locations as frequently as necessary to meet business needs (if travel is required).
• Maintains availability and willingness to work the schedule necessary to meet business needs.
• Works in a manner that is not disruptive to peers, supervisors, and/or subordinates.
• Demonstrates effective interpersonal skills and ability to act as a team player.
• Demonstrates ability to pay attention to detail, work in a fast-paced/evolving environment, and meet deadlines on a consistent basis.
• Demonstrates effective organizational skills and ability to manage multiple tasks.
• Demonstrates to successfully interact with members, medical professionals, and health plan and government representatives.

• Must reside in Oklahoma.
• Ability to work from Monday-Friday from 8am-5pm, with the flexibility to work beyond those core hours as needed.
• Lived experience as a health plan member (enrollee).
• 2+ years of experience in health care, preferably working with low-income or diverse populations, including a demonstrated knowledge of cultural sensitivity.
• 2+ years of experience in community outreach and engagement, encompassing effective telephonic skills, as well as verbal, written, and presentational communication skills.
• 2+ years of experience with personal computer, keyboard navigation, and Microsoft Office Suite applications.
• Must possess reliable transportation and be willing and able to travel in-state up to 25%. Mileage is reimbursed per our company expense reimbursement policy.

• Bilingual (Spanish) speaking skills.
• Medicaid/insurance experience.
• Cultural competency training experience.
• Claims processing experience.
• CPT, ICD-9-CM, and HCPCS experience.
• Community relations experience.
• Experience with managing appeals and grievances.
• Statistical analysis skills.

• High school diploma or GED.

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.