Member Advocate

Job Description

We are searching for a Member Advocate — someone who works well in a fast‑paced setting. The role investigates, resolves, and facilitates resolution of simple to moderately complex issues reported by Texas Children’s Health Plan (TCHP) members, prospective members, healthcare providers, or other entities related to TCHP Managed Care Organization. The Advocate acts as the first point of contact for assistance or information regarding eligibility, benefits, authorizations, claims, referrals, and other Member/Provider needs.

The Advocate assists and advocates for members and providers throughout the complaint and appeal process.

• Educate members about their rights and responsibilities, including the complaints and appeals process.
• Advocate for members during complaints, appeals, and hearings; ensure compliance with all necessary information for appropriate representation.
• Proactively solve problems and provide timely resolution to complex issues, identifying appropriate actions and communicating plans to stakeholders.
• Respond to internal system trouble notifications and coordinate with other departments as needed to resolve issues.
• Serve as a resource for team members’ questions and concerns, acting as an approachable point of contact.
• Evaluate, monitor, and coordinate community resources; maintain current knowledge of local and state resources.
• Coordinate with DARS and local resources to identify and support employment and training opportunities for members.
• Initiate collaboration with referral sources to link members/families to specialists, home care providers, financial assistance, housing, meals, transportation, and other community resources as appropriate.
• Assist manager in identifying opportunities for process and service improvement initiatives; participate in development and implementation of action plans.

• High School Diploma or GED.
• At least 2 years of customer service experience within managed care or the insurance industry.

Founded in 1996, Texas Children’s Health Plan is the nation’s first health maintenance organization created just for children. We provide STAR/Medicaid and Children’s Health Insurance Program (CHIP) coverage to pregnant women, teens, children, and adults in Houston and surrounding areas. The Health Plan serves more than 375,000 members who receive care from a network of over 1,100 primary care physicians, 3,200 specialists, and 70 hospitals.

Texas Children’s Health Plan is the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

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.