Member Advocate

Title: Member Advocate and Outreach Representative
Reports to: Manager, Operations
Classification: Individual Contributor
Location: Boston (Hybrid)

Job description revision number and date: V 2.1, 4.10.2025

 
Organization Summary:

Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Quality Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 with 9 health centers and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices across Massachusetts. We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.

Job Summary:

The Member Advocate and Outreach Representative will serve C3 enrollees, their representatives, and providers helping them navigate the ACO and ensuring they understand their benefits, rights, and responsibilities.

The ideal candidate will deliver exceptional customer service, demonstrate empathy and strong communication skills, thrive in a productive, fast-paced environment, be comfortable fielding inbound calls on a wide range of topics, and placing outbound calls to engage enrollees in appropriate care and C3 programs. As a growing organization, we are looking for a team member who can adapt as the organization evolves. The successful candidate should be able to provide support with daily operations and ongoing member and provider-related tasks of the department.

Responsibilities:

·   Respond to member and provider inquiries on a broad range of topics and in a variety of channels, including phone, mail, email, and fax. Answer incoming telephone calls promptly, politely, and professionally

·    Strive to answer questions and resolve issues during one call

·    Appropriately access information, systems, and resources as needed to resolve enrollee or provider issues, ideally during initial contact

·    Triage to or connect with resources such as the language line, care management, MassHealth, or other entities when necessary

·    Provide education and assistance to members on ACO policies and procedures and enrollee rights and responsibilities, including grievances and appeals

·    Follow C3’s and MassHealth’s grievance and appeals processes

·    Provide education and information to members on Community Partner Programs and other programs as necessary

·    Receive, respond to, and triage other types of callers, including provider offices, the general public, media outlets, or others and route appropriately to resolve inquiries

·    Follow the organization’s policies and procedures for handling each type of caller

· Conduct outbound calls for a range of purposes, including but not limited to completing Welcome Calls, demographic verification, Care Needs Screening, engaging members indifferent programs, including the Community Partner Program

·    Communicate with health centers, affiliated providers, and/or team members on appropriate course of action for member follow up

·    Coordinate the scheduling of patient assessments with health centers and/or team members for members enrolled in the Community Partners Program

·    Accurately and thoroughly document all communications, disposition, and resolution in the appropriate systems, in accordance with our policies and procedures, to enable monitoring, tracking, reporting, and analysis of call volume, outbound call disposition, and other statistics

·    Assist in reporting of those statistics as needed

·    Follow established regulations and procedures in collection, recording, storage and handling of information

·    Consistently meet contractual and organizational standards and expectations for call center performance (volume, timeliness, quality of service)

·    Collaborate with team members, other employees, and partners to effectively answer inquiries and resolve issues

·    Protect and preserve confidentiality of all MassHealth enrollees and members, and C3 information at all times in accordance with HIPAA requirements and our policies and procedures

·    Follow processes for fulfilling member requests for information, ID cards, or other materials

·    Process returned mail according to the organization’s policies and procedures

·    Represent the ACO in the community or at public forums as requested

·    Maintain high standards of professional conduct

·    Comply with all applicable policies and procedures, expectations, and standards

·    Attend required trainings

·    Perform other tasks, duties, or projects as assigned

Required Skills:

·       Ability and commitment to provide outstanding customer service

·       Ability to actively listen, demonstrate patience and empathy, and authentically engage with individuals in a caring and helpful manner

·       Ability to communicate clearly and professionally, both orally and in writing

·       Ability to identify and resolve problems and maintain composure and sound judgment in difficult or stressful situations

·       Ability to manage multiple priorities in an effective and organized manner

·       Strong attention to detail

·       Knowledge of and/or ability to learn and adhere to HIPAA rules, MassHealth contractual requirements, and other applicable regulations

·       Ability to learn new systems and tools, including for tracking/recording of contacts