Bilingual Spanish Resolution Specialist

🕒 2 days ago

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Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

👥 B2C

💰 $321.1M Post-IPO Debt - Alignment Health on 2024-11

Healthcare Insurance • B2C

Alignment Health is a Medicare-focused health insurance company that offers Medicare Advantage plans and member-centered services. It provides 24/7 on-demand access to care via in-person, in-home, and mobile channels and features a concierge-style on-demand card to help members schedule appointments, arrange transportation, and answer health questions. Alignment Health partners with brokers, providers, Accountable Care Organizations (ACOs), and institutional partners, operates in multiple U. S. states (including Arizona, California, Nevada, North Carolina, and Texas), and has earned high CMS ratings and industry recognition.

📋 Description

• Serve as a “subject matter expert” in escalated member calls (authorizations, claims, provider network issues) and be able to resolve these escalations based on level of understanding / experience of healthcare processes and protocols. • Identify process improvement opportunities within the member engagement department given the collaboration with different departments. • Knowledgeable in procedures, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries. • Conduct outbound phone calls and / or receive inbound phone calls within the department’s goal timeframe; successfully contact and manage to the member’s communication preferences as possible, which may include time of day, channel, and language; multi-lingual skills and / or utilize interpreter service as needed. • Collaborate with our partners, including other departments, supplemental benefit vendors, and provider network, to facilitate the member experience. • Identify members targeted for care gaps and other campaigns and connect members to programs or services when appropriate; analyze available programs, determine program eligibility, and connect member to appropriate provider or vendor. • Document real-time and conduct timely wrap-up to support outcomes reporting in all systems / applications by entering member demographics and information with accuracy and pay attention to detail, focusing on data integrity in support of quality organizational data. • Meet and exceed individual and team goals by submitting activity reports in the format and frequency required. • Provide excellent customer service and contribute to a culture of going “above and beyond” to ensure the highest level of member satisfaction. • Participate in all required team meetings and trainings and demonstrate satisfactory understanding of new information and process. • Adhere to all applicable attendance and productivity policies. • Assist with development and training of new hires including shadowing and nesting.

🎯 Requirements

• Minimum (1) year healthcare experience and / or training required; 3-4 years of healthcare experience / training required. • Minimum (1) year outbound call center experience which may include welcome / onboarding, appointment scheduling, retention, sales, or other health care / health plan related programs; and / or inbound call center experience that indicates a higher level of problem-solving such as escalation or resolution. • Experience helping members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations. • Experience helping members navigate their Medicare Advantage benefits including medical, prescription drug, and supplemental benefits. • High school diploma or general education degree (GED); or equivalent combination of education and experience. • Intermediate proficiency in Microsoft Office Suite (Outlook, Word, Excel) required. • Bilingual English and Spanish, Chinese (Mandarin or Cantonese), or Vietnamese. • Independent, motivated, self-starter who can prioritize work assignments and make every day a productive day. • Team player willing to help and support colleagues.

🏖️ Benefits

• Health insurance • 401(k) matching • Flexible work hours