Regional Concierge Navigator

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 Concierge Navigator Advocate provides outreach and support to ensure all our members have access to the care they deserve. You will navigate our members through their health care and benefits, and connect the dots between our provider network, health plan operations, and supplemental vendors. You will be alongside our members every step of the way to ensure they are never alone in their healthcare journey. This is a role for a passionate and experienced customer service representative who understands the meaningful contribution they make to our members’ healthcare outcomes.

GENERAL DUTIES/RESPONSIBILITIES (MAY INCLUDE BUT ARE NOT LIMITED TO):
1.    Demonstrates understanding of procedures, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries; serve as a “subject matter expert” in the health care experience that our members navigate daily
2.    Conducts member outreach phone calls and/or receiving inbound phone calls within the department’s goal timeframe; manage to the member’s communication preferences as possible, which may include time of day, channel, and language; utilize interpreter service as needed
3.    Collaborates with our partners – including but not limited to other departments, supplemental benefit vendors, and provider network – to facilitate the member experience
4.    Identifies 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
5.    Responsible for real-time documentation and timely wrap-up to support outcomes reporting in all systems/applications as required; must enter member demographics and information with accuracy and attention to detail, i.e. feel responsibility for the quality of our organizational data
6.    Excels in customer service and contribute to a culture of going “above and beyond” to ensure the highest level of member satisfaction
7.    Participates in all required team meetings and trainings, and exhibit satisfactory understanding of new information and process
8.    Supports other projects and duties as assigned by Management

Experience:

• Required: Minimum 1 year of experience helping members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations. Minimum 1 year of experience helping members navigate their Medicare Advantage benefits including medical, prescription drug, and supplemental benefits. Minimum one year of outbound call center experience which may include welcome/onboarding, appointment scheduling, retention, sales, or other health care/health plan related programs; and/or inbound call center experience that indicates a higher level of problem-solving such as escalation or resolution

Education:

• Required: High School Diploma or GED.

Specialized Skills:

• Required:

• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.

• 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.

• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;

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

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

• Problem-Solving Skills:  Effective problem solving, organizational and time manageme