Job Overview
Employment Type
Full-time
Compensation
Type:
Hourly
Rate:
Range $21.00 - $27.75
Work Schedule
Weekend Shifts
Night Shifts
Benefits
Health Insurance
Dental Insurance
Paid Time Off
Retirement Plan
remote work opportunity
Professional development opportunities
Paid holidays
Job Description
Alignment Healthcare is a leading healthcare company dedicated to providing exceptional care and service coordination for its members. The company specializes in Medicare Advantage plans that focus on delivering comprehensive healthcare solutions tailored to the needs of seniors and individuals with chronic conditions. Alignment Healthcare is committed to ensuring the highest standards of member satisfaction through innovative care models, extensive provider networks, and value-added supplemental benefits. Their core mission revolves around improving health outcomes by integrating personalized care and coordinated services, supported by advanced technology and compassionate service. The company's culture emphasizes a member-centric approach, putting patient experience at the... Show More
Job Requirements
- High school diploma or general education degree (GED)
- medical assistant certification
- medical front/back office experience
- knowledge of ICD-10 and CPT codes
- high-volume customer service experience in health plan or Medicare Member Services preferred
- telemarketing or member outreach experience preferred
- experience in escalation or resolution units preferred
- strong communication skills via email and phone
- fluency in Spanish, Korean, or Vietnamese a plus
- computer literate with typing 40+ words per minute
- ability to pass a writing test
- willingness to work overnight, weekends, and holidays as scheduled
- ability to work remotely
- reliable attendance and adherence to policies
Job Qualifications
- High school diploma or general education degree (GED)
- medical assistant certification required
- medical front/back office experience
- knowledge of ICD-10 and CPT codes
- high-volume inbound customer service experience, preferably in health plan or Medicare Member Services
- telemarketing or member outreach experience preferred
- specialized experience in escalation or resolution units preferred
- strong communication skills via email and phone
- fluency in written and verbal Spanish, Korean, or Vietnamese a plus
- ability to read and interpret procedural documents
- ability to write routine reports and correspondence
- computer literacy and strong computer skills
- typing speed of 40+ words per minute
- impeccable grammar and spelling
- must pass a writing test
Job Duties
- Be knowledgeable in procedures, protocols, benefits, services, and other necessary information to resolve member issues and inquiries
- serve as a subject matter expert in the healthcare experience our members navigate daily
- resolve incoming calls concerning members' eligibility, benefits, provider information, clinical, and pharmacy needs
- coordinate membership changes such as member's primary care physician
- proactively engage members with their wellness plan options
- collaborate with partners including other departments, supplemental benefit vendors, and provider network to facilitate the member experience
- receive inbound phone calls within the department's goal timeframe
- communicate with members in channels including e-mail, web chat, SMS/text
- manage member's communication preferences including time of day, channel, and language
- utilize interpreter service as needed
- document caller name, contact info, call reason, action taken, resolution in real-time and timely wrap-up
- provide administrative support to virtual providers with referrals and authorization requests
- coordinate member's care for PCP care plan, diagnostic tests, radiology, laboratory, and specialty appointments
- ensure appointments are scheduled and confirmed
- schedule transportation as appropriate
- manage appropriate clinical escalations and triage
- link members to appropriate clinical resources
- verify member inclusion in outreach or care gap programs and assist with enrollment
- monitor communication channels and manage replies to meet metrics
- develop, write, and edit digital replies
- follow communication scripts and templates
- excel in customer service and strive for highest member satisfaction
- adhere to attendance policies to ensure reliable queue coverage
Job Qualifications
Experience
Mid Level (3-7 years)
Job Location
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