Advocacy & Enrollment Coordinator

Benefits

Additional Information

Where compassion meets innovation and technology and our employees are family. Thank you for your interest in joining our team! Please review the job information below. GENERAL PURPOSE OF JOB The Advocacy and Enrollment Coordinator is responsible for coordinating complex member service operations related to enrollment, member advocacy, case navigation, and member engagement initiatives. This position supports Driscoll Health Plan's mission by improving access to care, ensuring regulatory compliance, enhancing member satisfaction, and promoting retention through effective outreach and resolution of member needs. The coordinator serves as a cross-functional resource to internal departments and supports operational excellence through reporting, trend analysis, workflow coordination, and continuous process improvement. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all- inclusive; employees will perform other reasonably related business duties as assigned by the Director of Member Services and Outreach. GENERAL RESPONSIBILITIES: Assists departmental leadership in ensuring all processes and workflows are accurately completed for enrollment, member advocacy, case navigation, and member engagement functions. Supports the identification, tracking, and analysis of trends, discrepancies, and operational opportunities related to member services and enrollment activities. Assists with the coordination of member inquiries, complaints, appeals, and state fair hearing activities. Supports the preparation, execution, and timely completion of departmental deliverables, projects, and initiatives. Demonstrates ethical business practices and personal conduct consistent with corporate compliance and integrity standards. Tracks, gathers, and analyzes data to prepare reports and summaries in support of member-related functions and leadership decision-making. Adheres to all Health System and Health Plan policies, procedures, and regulatory requirements. Maintains the highest level of confidentiality at all times. Collaborates cross-functionally with internal departments to support operational efficiency and member satisfaction. Performs other duties as assigned by the Director of Member Services and Outreach and Manager of Eligibility and Enrollment . Member Engagement & Retention Assists with oversight of outbound retention call campaigns designed to improve member engagement, renewal completion, and health plan retention. Supports development and execution of member retention strategies focused on reducing churn and strengthening long-term member relationships. Conducts proactive outreach through approved communication channels to encourage participation in programs and utilization of available services. Identifies barriers impacting enrollment, retention, or member engagement and escalates trends or concerns to leadership for action planning. Provides recommendations to enhance outreach messaging, communication timing, and engagement strategies to improve member response rates and program participation. Member Advocacy Responsibilities Provides strategic oversight and coordination of the Member Advocacy Program to ensure member needs are effectively addressed and all HHSC contractual requirements related to complaints, appeals, member rights, and responsibilities are fully met. Leads and guides advocacy staff in resolving complex member concerns, including but not limited to PCP changes, access to care barriers, quality of care issues, claims and billing disputes, and service denials. Ensures all member cases, concerns, and resolutions are thoroughly documented in accordance with regulatory, audit, and organizational standards. Oversees processes that ensure members are appropriately informed of and assisted with: o Member rights and responsibilities o HHSC Office of the Ombudsman functions and contact information o Complaint and appeal procedures o Covered benefits, including preventive services o Available non-capitated services and additional resources Coordinates cross-functional resolution efforts with Quality Management, Operations, Provider Relations, and other internal departments to ensure timely and compliant handling of complaints, appeals, and quality referrals. Analyzes advocacy trends, recurring member concerns, and service barriers, providing recommendations to leadership to improve member experience, operational workflows, and access to care outcomes. Assists with preparation and submission of required reports, regulatory documentation, and internal administrative deliverables, ensuring accuracy, timeliness, and compliance. Supports leadership in developing