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 Member Experience Associate assists plan members with their concerns or complaints and provides the necessary information and education to resolve concerns.
At Alignment Health, our mission is simple but powerful: to change senior health care. one person at a time !

EXPERIENCE:

• Required: Minimum two (2) years’ customer service/telemarketing experience. 1 year Medical front office experience. 1 year direct sales or related experience, preferably in the Medi-Cal, Commercial, or Medicare Managed Care industry.

EDUCATION:

• Required: High School Diploma or GED.
• Preferred: Associates Degree

SPECIALIZED SKILLS:

• Required:
• Knowledge of Medi-Cal, Commercial, and Medicare Managed Care Plans.
• 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.
• Microsoft Office Suite intermediate skills
• Preferred:
• Bilingual (English / Spanish) preferred.

• Explain plan’s procedures, protocols, benefits, services, and any other necessary information to the members who 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.
• 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 by manager.