Member Advocate

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

They assist and advocate for members and providers throughout the complaint and appeal process.

• Educates members about their rights and responsibilities, including the complaints and appeals process.
• Advocates for members during complaints, appeals, and hearings; ensures all necessary information for appropriate representation.
• Solves problems proactively and provides timely resolution to complex issues—identifying the most appropriate course of action and communicating plans to those impacted.
• Responds to internal system trouble notifications and coordinates with other departments as needed to facilitate problem resolution.
• Serves as a continual resource for team member questions and concerns, being primary available and approachable.
• Evaluates, monitors, and coordinates community resources, maintaining current knowledge of local and state resources.
• Coordinates with DARS and local resources to identify and support employment and training opportunities for members.
• Identifies options and initiates collaboration with referral sources to link members/families to specialists, home care providers, financial assistance, housing, meals, transportation, and other community resources as appropriate.
• Assists manager in identifying opportunities for process and service improvement initiatives and participates in development and implementation of action plans.

• H.S. Diploma or GED.
• 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 (HMO) created just for children. We provide STAR/Medicaid and Children’s Health Insurance Program (CHIP) 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 more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals.

Texas Children's Health Plan is also 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.

Entry level

Full-time

Legal

Hospitals and Health Care