Alignment Health is seeking a passionate, highly-motivated, and detail-oriented member experience associate to join the member experience team. The member experience associate will assist plan members with their concerns or complaints and provides the necessary information and education to resolve concerns.
Responsibilities:
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.
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 (positive attitude, helpful, etc.)
Perform other duties as assigned by manager.
Required Skills and Experience:
Minimum 3 months' related experience and / or training; or equivalent combination of education and experience.
Minimum 2 years' customer service / telemarketing experience.
Medical front office experience preferred.
Direct sales or related experience, preferably in the Medi-Cal, Commercial, or Medicare Managed Care industry.
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).
Knowledge of Medi-Cal, Commercial, and Medicare Managed Care Plans.
Bilingual English and Mandarin or Korean
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.
