Healthcare Call Center Lead (Hybrid Onsite in Orange, CA and Work-From-Home)

Overview of the Role:

Alignment Health is seeking a passionate, customer service oriented, and motivated hybrid remote member experience lead to join the member services team.  As a member experience lead, you will be a subject matter expert in the health care experience our members navigate daily. The lead will work alongside and conduct inbound and / or outbound member calls while concurrently role will empower and accelerate the performance of their team unit. As a member experience lead, you get to support team members with obtaining, maintaining, and enhancing the skills and training needed to provide excellent service to Alignment Health members.  You will do so through daily performance monitoring as it pertains to production, quality, and service to ensure that company goals and departmental metrics are met.

Location:

• Must be willing to work onsite in Orange, CA office headquarters at least 1-2 times per week (possibly more.)

Schedule:

• Monday through Friday
• Must be willing and able to be scheduled between 8am - 8pm Pacific Time
• Shifts rotate on a quarterly basis.
• Must be willing and to  work holidays on rotation.
• Must be willing to work (1) weekend a every other month.  (Will be able to make up time-off.)
• Must be willing to work (1) weekend during month of January.  (Will be able to make up time-off.)

No Time Off Approved During:

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

Responsibilities:

• Be knowledgeable in procedures, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries
• Serve as a “subject matter expert” to support assigned team with day-to-day questions
• Lead any specific projects, products, regions, or other specializations as assigned, including complex or VIP member issues
• Answer incoming member phone calls within the department’s goal time frame, and conducting outbound member phone calls in accordance with the department’s productivity metrics and goals
• Address complaints against the health plan and its contracted facilities according to applicable complaint or grievance procedure.
• Assist in defining and monitoring performance and productivity standards
• Assist with the onboarding of entry level staff including but not limited to ‘nesting’ and quality assurance of live call monitoring during the training period as required
• Collaborate with the trainer and quality assurance (QA) specialist in identifying training needs; participate in regular meetings with management to report call trends and identify opportunities for team improvement
• Assist with the daily process of all members regular and retro PCP transfers, ensuring that ‘supervisor’ approval is appropriate according to workflow
• Assist with monitoring attendance and schedule adherence
• Maintain confidentiality and uphold standards for privacy, data integrity, and security
• Encourage a spirit of cooperation, teamwork, and accountability among all department employees

Supervisory Requirements:

• Support the oversight of the day-to-day operations and performance of the call agents.
• Assist with the supervisory responsibilities of planning, assigning, and monitoring work.
• Assist in the rewarding and disciplining of assigned employees as needed or required.
• Address complaints and resolve problems as necessary.

Required Skills and Experience:

• Minimum 3 years’ customer service experience required.
• High school diploma or general education degree (GED); and three to five years related experience and / or training; or equivalent combination of education and experience required.
• Knowledge of Medicare Managed Care Plans required
• Previous lead experience or similar relevant experience required.
• Bilingual English / Spanish preferred
• 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 organ