Remote Quality Retention Specialist (Required to work PST hours and live in North Carolina)

About the role

The Quality Retention Specialist supports our members in their disenrollment requests and related quality assurance. They act in a customer-focused manner, genuinely interested in the needs of our members. This role involves addressing various customer-related needs and resolving call escalations.

Responsibilities

• Serves as a “subject matter expert” in escalated member calls at risk of disenrollment and resolves these escalations based on healthcare, processes, and protocols.
• Identifies process improvement opportunities within the Member Engagement department through collaboration with different departments.
• Meets and exceeds monthly goals as assigned.
• Acts as a subject matter expert in procedures, protocols, benefits, services, and other necessary information to resolve member issues and inquiries.
• Conducts outbound phone calls and/or receives inbound calls within the department’s goal timeframe, adapting to the member’s communication preferences.
• Collaborates with partners, including other departments, supplemental benefit vendors, and provider networks, to enhance the member experience.
• Shares best practices and participates in team meetings or training as required.
• Supports PCP/IPA terminations and ensures accurate real-time documentation and timely wrap-up to support outcomes reporting in all systems/applications.
• Assists with the development and training of new hires, including shadowing.
• Supports other projects and duties as assigned.

Requirements

• Minimum 1+ year of healthcare experience.
• At least 1+ year experience with Medi-Cal, Commercial, and Medicare Managed Care Plans and/or Sales, Customer Service, or Membership and Eligibility.
• Bachelor's degree or four years of additional experience in lieu of education.
• Preferred: Experience helping members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations, medical prescription drug, and supplemental benefits.

Qualifications

• High School Diploma or GED.
• Preferred: Solid knowledge and understanding of the Medicare Managed Care Manual Chapter 2 - Medicare Advantage Enrollment and Disenrollment and Medicare Communications and Marketing Guidelines.
• Effective communication skills, including positive, professional, and effective communication, leadership, teaching, and collaboration.
• Excellent written and oral communication skills, ability to establish and maintain relationships with diverse members, management, employees, and vendors.
• Ability to troubleshoot and solve problems, organize, and manage time in a fast-paced environment.
• Preferred: Bilingual in Spanish, Vietnamese, Mandarin, Cantonese, or Korean.
• Preferred: Sales License or completion of Alignment Health Plan sales certification.

Skills

• Strong knowledge of Medicare Managed Care Manual Chapter 2 - Medicare Advantage Enrollment and Disenrollment and Medicare Communications and Marketing Guidelines.
• Positive, professional, and effective communication skills.
• Ability to establish and maintain relationships with diverse members, management, employees, and vendors.
• Excellent written and oral communication skills.
• Ability to troubleshoot and solve problems, organize, and manage time in a fast-paced environment.
• Preferred: Bilingual in Spanish, Vietnamese, Mandarin, Cantonese, or Korean.

Benefits

Alignment Health offers comprehensive benefits to support your well-being and career growth. Details will be shared during the interview process.

Pay

$38,569.00 - $57,853.00 per year. Pay range may vary based on factors including market location, education, responsibilities, experience, etc.

Schedule

Flexible schedule to accommodate the needs of the position and the team.