Customer Service Representative

Job not on LinkedIn

November 7

🎰 Nevada – Remote

Although this job is listed in Nevada, this company may be open to hiring remote in other states.

💵 $41.7k - $62.5k / year

⏰ Full Time

🟢 Junior

💝 Customer Support

🚫👨‍🎓 No degree required

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Alignment Health

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Healthcare Insurance • Insurance • Healthcare

Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

💰 $135M Series C on 2020-03

📋 Description

• Provides in-market, specialized member support in respective market or region • Conducts in-market member engagement including Welcome Calls, New Member Onboarding, JSA Scheduling, High Quality PCP and Provider Terms, Product/Vendor Changes, CAHPS Proxy, Disenrollment Quality Assurance, and Proactive Service Recovery • Conducts case follow-ups and quality member issue resolution for all cases assigned • Ensures members have access to PCP and specialists to coordinate care • Educates members on gaps in care and assists with scheduling provider appointments • Serves as the patient's liaison throughout the life cycle of the program by addressing program specific quality measures and adhering to company guidelines/standard operating procedures • Makes appropriate and timely patient appointments, reminders, and confirmations • Mails letters and correspondence as needed • Places regular/consistent outreaches to the patient • Communicates with PCP with any member updates and requests • Assists with obtaining medical records from any healthcare providers involved in care or hospitals • Helps members with any authorizations and referrals involved in their care plan • Resolves incoming calls concerning members’ eligibility, benefits, provider information, clinical, and pharmacy needs; coordinate membership changes such as member’s primary care physician and proactively engage member with their wellness plan options • Participates in on-site member engagement activities as needed, such as in-person member meetings, handling lobby calls at a retail or care center location, etc. (subject to change).

🎯 Requirements

• Minimum 1 year of customer service experience • High-volume inbound customer service experience, particularly for health plan or Medicare ‘Member Services’ roles preferred • Telemarketing and/or member outreach experience preferred • Specialized experience in escalation or resolution units preferred • High School Diploma or GED required • Knowledge of ICD-10 and CPT codes required • Keyboard typing 40+ words per minute required • Ability to help members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations required • Ability to communicate positively, professionally and effectively with others required • Effective written and oral communication skills required • Ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors required • Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals required • Ability to write routine reports and correspondence required • Ability to speak effectively before groups of customers or employees of the organization required • Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions required • Ability to deal with problems involving a few concrete variables in standardized situations required • Ability to perform mathematical calculations and calculate simple statistics correctly required • Effective problem solving, organizational and time management skills preferred • Ability to work in a fast-paced environment required • Bilingual English/Spanish or English/Vietnamese or English/Mandarin preferred • Fluency in written and verbal Spanish, Korean, or Vietnamese a plus.

🏖️ Benefits

• None specified