Remote Bilingual Spanish Resolution Specialist

About the role

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Resolutions Specialist provides member issue resolution managing and resolving healthcare insurance claims in a timely and accurate manner. This role requires solid analytical skills, knowledge of healthcare insurance policies, and a commitment to providing exceptional service to policyholders, healthcare providers, and internal stakeholders.

Alignment Health is seeking a bilingual Spanish resolution specialist to join the member engagement team to provide member issue resolution. As a resolution specialist, you will intake complex member cases and provide prompt and satisfactory resolution. You will be dedicated to decreasing turnaround time, improving the quality of resolution, and managing barriers to resolution as part of process improvement and Voice of the Customer (VoC).

Schedule

Monday through Friday, with shifts aligned to the following time zones:

• Pacific Time: 8:00am – 5:00pm
• Mountain Time: 9:00am – 6:00pm
• Central Time: 10:00am – 7:00pm
• Eastern Time: 11:00am – 8:00pm

No time off is permitted during the first five-week training period. Annually, no time off is approved during the entire month of January due to peak volume (no exceptions).

Responsibilities

• Serve as a “subject matter expert” in escalated member calls (authorizations, claims, provider network issues) and resolve these escalations based on level of understanding and experience of healthcare processes and protocols.
• Identify process improvement opportunities within the member engagement department given collaboration with different departments.
• Maintain knowledge of 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 (time of day, channel, language); use multi-lingual skills and/or interpreter services as needed.
• Collaborate with 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 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.

Required Skills and Experience

• Minimum 1 year healthcare experience and/or training required; 3–4 years of healthcare experience/training preferred.
• Minimum 1 year outbound call center experience (welcome/onboarding, appointment scheduling, retention, sales, or other health care/health plan related programs) and/or inbound call center experience indicating 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 in English and Spanish, Chinese (Mandarin or Cantonese), or Vietnamese.
• Independent, motivated self-starter who can prioritize work assignments and make every day productive.
• Team player willing to help and support colleagues and do their part to support organizational goals.
• Ability to learn, describe, explain, and educate members about health plan coverage and services.
• Passionate about customer service and member retention.
• Excellent customer service skills and comfort being on the phone.
• Ability to troubleshoot and problem solve.
• 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.
• Ability to add, subtract, multiply, and divide using units of American money, weight, volume, and distance.
• 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.

Work Environment

Must be available annually to work full-time and overtime through the Annual Enrollment Period (October through December) and Open Enrollment Period (January through March).

Pay Range

$41,600.00 – $57,600.00 per year. Pay range may be based on factors including market location, education, responsibilities, and experience.