Member Experience Associate

 

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Job Number 5094

Remote-US , California

Alignment Health was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Health team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. 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 community.

Position Summary:

The Member Experience Associate II is a key member of the Member Services team that assists plan members with their concerns or complaints and provides the necessary information and education to resolve concerns. This position is expected to have experience in servicing members in the Medi-Cal, Commercial, or Medicare Managed Care industry, providing excellent customer service, being knowledgeable of health plans, and following call escalation protocol as needed.

General Duties/Responsibilities (May include but are not limited to):

• Excel in customer service and contribute to a culture of going “above and beyond” to ensure the highest level of member satisfaction.

• Be knowledgeable in procedures, protocols, benefits, services, and explain necessary information to resolve member issues and inquiries that call or visit the member experience department.

• Facilitate member requests for changes with network provider changes, transportation requests, or any other member request for assistance as appropriate.

• Answer all incoming member phone calls within the department’s goal time frame.

• Document every incoming call during the call with pertinent details (i.e., caller name, contact info, reason for call, action taken, resolution, etc.)

• Respond to complaints against the health plan and its contracted facilities by utilizing the departments Complaint / Grievance Policy and Procedure.

• Make all attempts to resolve all member dis-enrollment / cancellation requests, complaint / grievances, and assist the member with their questions or concerns and following up as appropriate.

• Assist with member outreach programs and implementations as needed.

• Foster good corporate relations by practicing good customer service principles (i.e., positive attitude, helpful, etc.)

• Perform other duties as assigned.

Supervisory Responsibilities:

N/A

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Minimum Experience:
  • 1-2 years of related experience in Medi-Cal, Commercial, or Medicare Managed Care industry, preferred.

  • Minimum three years' customer service, telemarketing, or other call center experience.

• Education/Licensure:
  • High school diploma or general education degree (GED); one to three months related experience and/or training; or equivalent combination of education and experience.

  • Associate degree (AA) degree (preferred).

• Other:
  • Bilingual in Spanish/Vietnamese/Korean, Mandarin/Cantonese) preferred.

  • Knowledge of Medi-Cal, Commercial, and Medicare Managed Care Plans.

  • Strong sense of excellent customer service.

  • Excellent communication skills, oral and written.

  • Strong organizational skills and the ability to prioritize.

  • Self-starter and able to work independently.

  • Language skills: 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 of the organization.

  • Mathematical skills: Able to add and subtract two-digit numbers and to multiply and divide with 10’s and 100’s. Able to perform these operations using units of American money and weight measurement, volume, and distance.

  • Reasoning skills: Able to apply common sense understanding to carry out detailed but un-involved written or verbal instructions. Able to deal with problems involving a few concrete variables in standardized situations.

  • Strong Computer skills: Minimum typing 40 WPM, Microsoft Outlook, Word, Excel.

• Work Environment:

• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.

• The employee is frequently required to walk; stand; reach with hands and arms.

• The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.

• The employee must occasionally lift and/or move up to 20 pounds.

• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• The noise level in the work environment is usually moderate.

Alignment requires all new hires to follow local and/or state requirements regarding the COVID-19 vaccine and booster. If applicable, proof of vaccination and booster will be required as a condition of employment subject to legal exemptions. This policy, which Alignment reserves the right to modify, is part of Alignment’s ongoing efforts to ensure the safety and well-being of its staff and community and to support public health efforts.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact careers@ahcusa.com.

• 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.

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