Bilingual Resolution Specialist

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 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.

RESPONSIBILITIES: 
1.    Serves as a “subject matter expert” in escalated member calls (authorizations, claims, provider network issues) and be able to resolve these escalations based on level of understanding / experience of healthcare processes and protocols.
2.    Identifies process improvement opportunities within the member engagement department given the collaboration with different departments.
3.    Knowledgeable in procedures, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries.
4.    Conducts outbound phone calls and / or receive inbound phone calls within the department’s goal timeframe; successfully contact and manage to the member’s communication preferences as possible, which may include time of day, channel, and language; multi-lingual skills and / or utilize interpreter service as needed.
5.    Collaborates with our partners, including other departments, supplemental benefit vendors, and provider network, to facilitate the member experience.
6.    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.
7.    Documents real-time and conduct timely wrap-up to support outcomes reporting in all systems / applications by entering member demographics and information with accuracy and pay attention to detail, focusing on data integrity in support of quality organizational data.
8.    Provides excellent customer service and contribute to a culture of going “above and beyond” to ensure the highest level of member satisfaction.
9.    Participates in all required team meetings and trainings and demonstrate satisfactory understanding of new information and process.
10.    Assist with development and training of new hires including shadowing and nesting.
11.    Other duties as assigned

Job Requirements:

Experience:

• Required: Minimum one (1) year healthcare experience. Minimum one (1) year 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. 1+ years of experience helping members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations. Minimum 1 year experience helping members navigate their Medicare Advantage benefits including medical, prescription drug, and supplemental benefits.

• Preferred: 3-4 years of healthcare experience

Education:

• Required: High School Diploma or GED.  

• Preferred: College courses

Specialized Skills:

• Required:

• Able to describe, explain, and educate our members about health plan coverage and services.
• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
• Intermediate proficiency in Microsoft Office Suite (Outlook, Word, Excel) required
• 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.
• 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