Remote-Customer Service Representative (Bilingual in Spanish)

Alignment Health is committed to serving seniors and those who need it most, focusing on transforming their lives through dedicated care. The Remote Regional Concierge Navigator will provide outreach and support to members, ensuring they have access to necessary healthcare and benefits, while maintaining high knowledge of member needs.

Responsibilities:

• 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 and 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)
• Other duties as assigned

Requirements:

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