Bilingual Spanish Resolution Specialist

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $41.6k - $57.6k / year

⏰ Full Time

🟢 Junior

💬 Bilingual

🚫👨‍🎓 No degree required

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

🛡️ Insurance

🏥 Healthcare

💰 $135M Series C on 2020-03

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.

📋 Description

• Provide member issue resolution for healthcare insurance claims • Intake complex member cases and provide prompt, satisfactory resolution • Serve as a subject matter expert for escalated member calls involving authorizations, claims, and provider network issues • Identify process improvement opportunities within the member engagement department • Explain procedures, protocols, benefits, and services to resolve member issues and inquiries • Conduct outbound and receive inbound calls within department timeframes • Manage member communication preferences, including time of day, channel, and language • Collaborate with departments, supplemental benefit vendors, and provider network partners • Identify members for care gaps and campaigns, analyze program eligibility, and connect members with appropriate programs, providers, or vendors • Document member information accurately in systems and applications and complete timely wrap-up activities • Submit activity reports and meet individual and team goals • Participate in required team meetings and trainings • Adhere to attendance and productivity policies • Assist with development and training of new hires through 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 and/or inbound call center experience involving escalation or resolution • Experience helping members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations • Experience helping members navigate Medicare Advantage benefits, including medical, prescription drug, and supplemental benefits • High school diploma or GED; or equivalent combination of education and experience • Intermediate proficiency in Microsoft Office Suite (Outlook, Word, Excel) • Bilingual English and Spanish, Chinese (Mandarin or Cantonese), or Vietnamese • Ability to work full-time and overtime during Annual Enrollment Period and Open Enrollment Period • Ability to troubleshoot, problem solve, interpret documents, write routine reports and correspondence, and speak effectively before groups • Ability to perform basic arithmetic using American money and measurement units • Ability to follow detailed written or oral instructions and solve problems involving standardized situations • Independent, motivated self-starter able to prioritize work assignments • Team-oriented and willing to support colleagues • Passion for customer service and member retention • Comfortable being on the phone

🏖️ Benefits

• Full-time employment • Overtime availability during the Annual Enrollment Period and Open Enrollment Period • Opportunities for growth and innovation • Equal Opportunity/Affirmative Action employment