Hybrid-Customer Experience Lead (Orange, CA)

About the role

The Hybrid Member Experience & Engagement Lead at Alignment Health plays a crucial role in supporting the health care experience of members. This position requires a deep understanding of Medicare Managed Care Plans and involves leading projects, managing team performance, and resolving member issues.

Responsibilities

• Acts as the subject matter expert for procedures, protocols, benefits, services, and other necessary information to resolve member issues and inquiries.
• Assumes the tier two role, answering incoming member phone calls within the department's goal time frame and conducting outbound member phone calls in accordance with productivity metrics and goals.
• Addresses complaints against the health plan and its contracted facilities according to applicable complaint or grievance procedures.
• Affords support in defining and monitoring performance and productivity standards.
• Assists in the onboarding of entry-level staff, including 'nesting' and quality assurance of live call monitoring during the training period as required.
• Collaborates with the Trainer and QA Specialist in identifying training needs; participates in regular meetings with management to report call trends and identify opportunities for team improvement.
• Maintains confidentiality and upholds standards for privacy, data integrity, and security.
• Encourages a spirit of cooperation, teamwork, and accountability among all department employees.
• Performs other duties as assigned.

Requirements

• Minimum of 1 to 2 days in the office a week.
• Minimum three (3) years of customer service experience, with five (5) years preferred.
• Healthcare experience.
• Previous Lead experience.

Qualifications

• High School Diploma or GED.
• College courses preferred.
• Knowledge of Medicare Managed Care Plans required.
• Type 40+ words per minute and ability/experience with 10-key by touch.
• Positive, professional, and effective communication skills.
• Ability to communicate with diverse members, management, employees, and vendors.
• Mathematical Skills: Ability to add and subtract two-digit numbers and to multiply and divide with 10’s and 100’s.
• Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.
• Problem-Solving Skills: Effective problem solving, organizational, and time management skills, and ability to work in a fast-paced environment.
• Bilingual (English/Spanish) preferred.

Skills

• Knowledge of Medicare Managed Care Plans.
• Ability to communicate positively, professionally, and effectively with others.
• Ability to establish and maintain a constructive relationship with diverse members, management, employees, and vendors.
• Effective written and oral communication skills.
• Advanced problem-solving and organizational skills.
• Ability to prioritize multiple tasks.
• Advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement, and manage appropriate resolutions.
• Ability to work in a fast-paced environment.

Benefits

Alignment Health offers a comprehensive benefits package designed to support the health and well-being of our employees. This includes medical, dental, vision, retirement plans, and paid time off.

Pay

The pay range for this position is $44,790.00 - $67,185.00, which may vary based on factors such as market location, education, responsibilities, experience, etc.

Schedule

The Hybrid Member Experience & Engagement Lead works a flexible hybrid schedule, requiring a minimum of 1 to 2 days in the office a week.

Company Information

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.