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 & 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 Chinese (Mandarin)
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.
Computer skills: Strong computer skills.
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Physical Functions
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
The employee is frequently required to walk; stand; reach with hands and arms.
The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.
The employee must occasionally lift and / or move up to 20 pounds.
Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate.
