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Resolution Specialist Jobs
Company | Alignment Health |
Address | California, United States |
Employment type | FULL_TIME |
Salary | |
Category | Hospitals and Health Care |
Expires | 2023-09-14 |
Posted at | 9 months ago |
Job Number: 5744
- Be knowledgeable in procedures, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries
- Assist with the development and training of new hires including shadowing and nesting
- Collaborate with our partners – including but not limited to other departments, supplemental benefit vendors, and provider network – to facilitate the member experience
- Must participate in all required team meetings and trainings, and exhibit satisfactory understanding of new information and process
- Identify process improvement opportunities within the Member Engagement department given the collaboration with different departments
- Support other projects and duties as assigned by Management
- Adhere to all applicable attendance and productivity policies
- Excel in customer service and contribute to a culture of going “above and beyond” to ensure the highest level of member satisfaction
- Responsible for conducting outbound phone calls and/or receiving 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
- Responsible for meeting or exceeding individual and team goals, and for submitting activity reports in the format and frequency required
- Responsible for real-time documentation and timely wrap-up to support outcomes reporting in all systems/applications as required; must enter member demographics and information with accuracy and attention to detail, i.e. feel responsible for the quality of our organizational data
- Identify 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
- Serve as a “subject matter expert” in escalated member calls (i.e. authorizations, claims, provider network issues) and be able to resolve these escalations based on level of understanding/experience of healthcare, processes and protocols
- Computer Skills: Intermediate MS Suite knowledge and experience
- Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.
- Minimum Experience:
- Excellent customer service and comfortable being on phones
- Minimum of 1-2 years healthcare experience and/or training required; 3-4 years of healthcare experience/training preferred
- Ability to troubleshoot/problem solve
- 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
- Bilingual: English/Spanish, or Vietnamese, Chinese (Mandarin), Korean
- Experience helping members navigate their Medicare Advantage benefits including medical, prescription drug, and supplemental benefits
- Must be available to work full-time and over-time through the Annual Enrollment Period (Oct-Dec) and Open Enrollment Period (Jan-Mar)
- Natural “teacher” with the ability to learn plans and describe/explain/educate healthcare coverage and services to our members
- Genuine passion for customer service and member retention
- Work Environment
- Education and/or Experience:
- Team player willing to help and support colleagues, and do their part to support us all reaching our organizational goals
- 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.
- Experience helping members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations
- Independently motivated self-starter who can prioritize work assignments and make every day a productive day
- High school diploma or general education degree (GED); or equivalent combination of education and experience.
- Preferred:
- While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
- The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
- DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].
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