[Hiring] Bilingual Spanish Resolution Specialist @Alignment Health

Role Description

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

No Time Off Approved During:
• No time off is permitted during the first (5) week training period.
• Annually during the entire month of January due to it being the busiest time of the year (no exceptions).

Responsibilities
• Serve as a “subject matter expert” in escalated member calls (authorizations, claims, provider network issues) and resolve these escalations based on understanding/experience of healthcare processes and protocols.
• Identify process improvement opportunities within the member engagement department given the collaboration with different departments.
• Knowledgeable in 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; manage member communication preferences, including time of day, channel, and language.
• Collaborate with partners, including other departments, supplemental benefit vendors, and provider network, to facilitate the member experience.
• Identify members targeted for care gaps and connect them to programs or services when appropriate; analyze available programs and determine eligibility.
• Document real-time and conduct timely wrap-up to support outcomes reporting in all systems/applications.
• Meet and exceed individual and team goals by submitting activity reports in the required format and frequency.
• Provide excellent customer service and contribute to a culture of going “above and beyond” for member satisfaction.
• Participate in all required team meetings and trainings and demonstrate satisfactory understanding of new information and processes.
• Adhere to all applicable attendance and productivity policies.
• Assist with development and training of new hires including shadowing and nesting.

Qualifications
• Minimum (1) year healthcare experience and/or training required; 3-4 years of healthcare experience/training preferred.
• Minimum (1) year outbound call center experience, including welcome/onboarding, appointment scheduling, retention, sales, or other healthcare-related programs.
• 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.
• Team player willing to help and support colleagues.
• Passionate about customer service and member retention.
• Excellent customer service skills and comfortable being on the phone.
• Able to troubleshoot and problem solve.
• Able to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
• Able to write routine reports and correspondence.
• Able to speak effectively before groups of customers or employees.
• Able to perform basic mathematical operations.
• Able to apply common sense understanding to carry out detailed instructions.
• Able to deal with problems involving a few concrete variables in standardized situations.

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

Benefits
• Pay Range: $41,600.00 - $57,600.00
• Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Company Description

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.

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