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.

Member Inquiry & Benefits Navigation

• Provide accurate, timely, and empathetic information on Medicare Advantage benefits
• Assist members and representatives in understanding the plan’s benefits and services.
• Facilitate enrollment, disenrollment, and plan change processes.
• Serve 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.
• Communicate relevant member service issues, unmet needs, or quality concerns to assigned Care Managers or Case Managers for clinical follow-up.
• Assist members and facility staff in understanding prior authorization requirements and status for institutional and ancillary services.
• Route authorization requests to the appropriate Utilization Management team and communicate status updates to requesting parties.
• Maintain 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.
• Adhere to all HIPAA privacy and security regulations in handling Protected Health Information (PHI).
• Complete all required CMS and plan-mandated training on an ongoing basis, including Annual Compliance Training, SNP-specific training, and Medicare Advantage regulations.
• Support 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).
• Explain member rights under the Medicare Advantage Appeals and Grievance process, including the right to request an Independent Review Entity (IRE) review.
• Coordinate with the Medical Management, Claims, and Compliance teams to ensure timely resolution and member notification.
• Track 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.
• Assist with Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) distribution and answering related questions during open enrollment periods.
• Coordinate and host facility and community member engagement events.

• High school diploma or GED required; Associate's or Bachelor's degree in Healthcare Administration, Social Work, Business, or related field preferred.
• Minimum of 2 years of experience in a healthcare member services, customer service, or health plan operations role.
• Prior experience in a Medicare Advantage, managed care, or long-term care/post-acute environment strongly preferred.
• Strong verbal and written communication skills with the ability to communicate complex benefit information in plain language.
• Demonstrated empathy and person centered communication skills, particularly with vulnerable elderly or disabled populations.
• Proficiency with CRM systems, member management platforms, and Microsoft Office Suite (Word, Excel, Outlook).
• Ability to manage a high volume of contacts while maintaining quality and regulatory compliance.
• Strong attention to detail and organizational skills, with the ability to prioritize and meet strict regulatory deadlines.
• Ability to work collaboratively within a multidisciplinary team environment.

At BrightSpring Health Services, our LEGACY culture guides how we lead, how we serve, and how we show up for one another. We are committed to doing the right thing—leading with integrity, accountability, and transparency in all that we do. As part of this commitment, we share that we may use third-party artificial intelligence (AI) to process employment data in connection with our hiring processes. Any AI tool that we use always has humans in the loop; we do not use AI to automate employment decisions or to discriminate, and we do not use zip codes as proxy. Humans – our hiring leaders and recruiter – make final decisions. BrightSpring Health Services provides reasonable accommodations to qualified applicants and employees with disabilities; if you would like to request a reasonable accommodation, please contact your recruiter or send an inquiry to TalentAcquisition@brightspringhealth.com. For more information about how our company uses AI in the hiring process, contact TalentAcquisition@brightspringhealth.com.

BrightSpring Health Services and its affiliated companies provide equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

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