Customer Engagement Member Advocate III

Salary and About

Salary Range: $77,265.00 (Min.) - $ (Mid.) - $ (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we ensure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County s vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

The Customer Engagement and Experience Member Advocate III serves as a high-level resource and member support specialist within L.A. Care’s Customer Engagement and Experience operations. This position advocates and assists members in navigating their health plan benefits, accessing care, resolving issues, addressing waste and abuse, and connecting to community, clinical, and social services. It handles complex, sensitive, or escalated cases, provides guidance to other advocates, and collaborates across departments to improve the member experience.

This role supports retention, satisfaction, and access to care for underserved populations and acts as a Subject Matter Expert (SME), serving as a resource and mentor for other staff.

• Assists members with complex benefit questions, care navigation challenges, grievances, access to services, and issue resolution.
• Conducts high-touch outreach to support vulnerable or high-risk populations, including seniors, individuals with chronic conditions, and members with unmet social needs.
• Serves as a subject matter expert for benefit interpretation, care coordination pathways, and service workflows; resolves escalated inquiries from customer service, care management, and provider relations.
• Helps members understand coverage, Primary Care Physician (PCP) selection, referrals, authorizations, and healthcare system processes.
• Connects members to community resources related to housing, food, transportation, financial assistance, behavioral health, and other social determinants of health (SDoH) needs.
• Coordinates with cross-functional key stakeholders to remove barriers to care.
• Supports member engagement initiatives such as health literacy outreach, preventive care reminders, redetermination support, and quality-improvement campaigns (e.g., HEDIS, CAHPS).
• Participates in member experience programs focused on improving satisfaction, retention, and service outcomes; documents member feedback and identifies recurring pain points for operational improvement.
• Works closely with cross-functional key stakeholders to address member needs; assists with complex cases requiring multi-department coordination; serves as a representative for Member Advocacy on work groups or improvement projects.
• Accurately documents all member interactions, interventions, and referrals in the plan’s systems; escalates potential quality-of-care issues, safety concerns, or compliance risks; maintains confidentiality per HIPAA and managed care regulations; supports audit readiness through timely, accurate, and complete documentation.
• Applies subject matter expertise in evaluating business operations and processes; identifies areas where technical solutions would improve performance; consults across operations, provides mentorship, and contributes specialized knowledge; ensures accuracy of program deliverables and recommends process improvements as needed.
• Performs other duties as assigned.

• Education Required: Associate's Degree
• In lieu of degree, equivalent education and/or experience may be considered.
• Education Preferred: Bachelor s Degree in Healthcare or Related Field

• Required: At least 5 years of experience in member services, advocacy, care coordination, customer service, or healthcare navigation; experience with vulnerable, underserved, and culturally diverse populations; experience resolving individual cases with regulatory state agencies.
• Preferred: Experience in Medicaid, Medicare, or managed care environments.

• Required: Strong…