US-KY-LOUISVILLE

US-TN-NASHVILLE

US-KY-BOWLING GREEN

US-IN-EVANSVILLE

US-IN-INDIANAPOLIS ID 2026-191841

Line of Business Abilis Health Plan Position Type Full-Time Our Company Abilis Health Plan Overview The Member Services Analyst for the Institutional and Institutional Equivalent Special Needs Plan (I/IE-SNP) serves as the primary point of contact for membership operations. This role is responsible for delivering exceptional, person centered service to a uniquely vulnerable population by addressing inquiries related to benefits, authorizations, enrollments, claims, grievances, and appeals in full compliance with CMS regulations and the plan's Model of Care (MOC). This position collaborates closely with Interdisciplinary Care Teams (ICTs), facility staff, authorized representatives, family members, and internal teams to ensure members concerns are resolved timely. Responsibilities Member Inquiry & Benefits Navigation Provide accurate, timely, and empathetic information on Medicare Advantage benefits\nAssist members and representatives in understanding the plan's benefits and services.\nFacilitate enrollment, disenrollment, and plan change processes.\nServe as a liaison between members, authorized representatives, facility nursing and social work staff, and the plan's Interdisciplinary Care Team (ICT) to support care coordination activities.\nCommunicate relevant member service issues, unmet needs, or quality concerns to assigned Care Managers or Case Managers for clinical follow-up.\nAssist members and facility staff in understanding prior authorization requirements and status for institutional and ancillary services.\nRoute authorization requests to the appropriate Utilization Management team and communicate status updates to requesting parties.\nMaintain complete and accurate records of all member interactions in the plan's CRM or member management system in accordance with CMS and internal documentation standards.\nAdhere to all HIPAA privacy and security regulations in handling Protected Health Information (PHI).\nComplete all required CMS and plan-mandated training on an ongoing basis, including Annual Compliance Training, SNP-specific training, and Medicare Advantage regulations.\nSupport audit readiness by ensuring documentation quality and accuracy consistent with plan policies. Grievances, Appeals & Coverage Determinations Intake, document, and process member grievances and appeals in accordance with CMS regulatory timeframes (standard and expedited).\nExplain member rights under the Medicare Advantage Appeals and Grievance process, including the right to request an Independent Review Entity (IRE) review.\nCoordinate with the Medical Management, Claims, and Compliance teams to ensure timely resolution and member notification.\nTrack and monitor open cases to ensure adherence to required CMS timelines; escalate as needed. Member Outreach & Education Educate members and facility staff on how to access plan services, how to request care, and how to use the plan's provider network.\nAssist with Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) distribution and answering related questions during open enrollment periods.\nCoordinate and host facility and community member engagement events. Qualifications High school diploma or GED required; Associate's or Bachelor's degree in Healthcare Administration, Social Work, Business, or related field preferred.\nMinimum of 2 years of experience in a healthcare member services, customer service, or health plan operations role.\nPrior experience in a Medicare Advantage, managed care, or long-term care/post-acute environment strongly preferred.\nStrong verbal and written communication skills with the ability to communicate complex benefit information in plain language.\nDemonstrated empathy and person centered communication skills, particularly with vulnerable elderly or disabled populations.\nProficiency with CRM systems, member management platforms, and Microsoft Office Suite (Word, Excel, Outlook).\nAbility to manage a high volume of contacts while maintaining quality and regulatory compliance.\nStrong attention to detail and organizational skills, with the ability to prioritize and meet strict regulatory deadlines.\nAbility to work collaboratively within a multidisciplinary team environment. About our Line of Business Abilis Health Plan, an affiliate of BrightSpring Health Services, is a Medicare Advantage Plan covering all the benefits of Original Medicare (Parts A and B) with prescription drug coverage (Part D). The Abilis Health Plan is a unique plan allowing members to enroll year-round. The plan focuses on members who meet residential requirements in participating nursing facilities. An interdisciplinary team of clinicians and innovative services allow us to meet each member's clinical needs and provide preventive, coordinated, and quality healthcare. With a dedicated nurse practitioner leading a personalized care plan, we strive to improve the health of the communities in which we serve. For more information, please visit www.abilishealth.com. 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