Remote-Customer Service Representative (Bilingual in Spanish)

General Duties/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.

Aids members 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).

Experience Job Requirements

• Minimum 1 year of customer service experience.
• PREFERRED: 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.

Education Required

• High School Diploma or GED.

Specialized Skills Required

• 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;
• Language Skills: 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.
• Reasoning Skills: 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.
• Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly.
• Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.

Preferred

• Bilingual English/Spanish or English/Vietnamese or English/Mandarin.
• Linguistic Skills: Fluency in written and verbal Spanish, Korean, or Vietnamese, a plus.

Licensure Required

• None

Work Environment

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Essential Physical Functions: While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
• The employee frequently lifts and/or moves up to 10 pounds.
• Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range

$44,790.00 - $67,185.00

Disclaimer

Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.