Required: Minimum 1 year of customer service experience.
Preferred: High-volume inbound customer service experience, particularly for health plan or Medicare "Member Services" roles in health plan and supplemental benefits preferred. Telemarketing and/or member outreach experience preferred. Specialized experience in escalation or resolution units preferred.
Education:
Required: High School Diploma or GED.
Specialized Skills:
Required:
Knowledge of ICD-10 and CPT codes.
Keyboard typing 40+ words per minute.
Ability to help members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations.
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
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.
Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
Preferred: Bilingual English/Spanish or English/Vietnamese or English/Mandarin. Fluency in written and verbal Spanish, Korean, or Vietnamese, a plus.
Licensure:
Required: None
Work Environment
The
Benefits
Health insuranceRemote work options
Additional Information
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 Remote Regional Concierge Navigator provides outreach and support to all our members, ensuring they have access to the care they deserve. Supports our members to navigate through their health care and benefits. Connects the dots between our provider network, health plan operations, and supplemental vendors. Maintains a high knowledge of the member needs of their respective market and assist our members every step of the way to ensure they are never alone in their healthcare journey and have the highest level of coordinated care. Lays the groundwork for future and ongoing member support. Has familiarity with assigned markets and understands the meaningful contributions to members' healthcare outcomes.
ENERAL DUTIES/RESPONSIBILITIES
1. Provides in-market, specialized member support in respective market or region.
2. Conducts in-market member engagement including Welcome Calls, New Member Onboarding, JSA Scheduling, High Quality PCP and Provider Terms, Product/Vendor Changes, CAHPS Proxy, Disenrollment Quality Assurance, and Proactive Service Recovery
3. Conducts case follow-ups and quality member issue resolution for all cases assigned.
4. Ensures members have access to PCP and specialists to coordinate care.
5. Educates members on gaps in care and assists with scheduling provider appointments.
6. Serves as the patient's liaison throughout the life cycle of the program by addressing program specific quality measures and adhering to company guidelines/standard operating procedures.
7. Makes appropriate and timely patient appointments, reminders, and confirmations and Mails letters and correspondence as needed.
8. Places regular/consistent outreaches to the patient
9. Communicates with PCP with any member updates and requests.
10. Assists with obtaining medical records from any healthcare providers involved in care or hospitals.
11. Helps members with any authorizations and referrals involved in their care plan.
12. Resolves incoming calls concerning members' eligibility, benefits, provider information, clinical, and pharmacy needs; coordinate membership changes such as member's primary care physician and proactively engage member with their wellness plan options.
13. Participates in on-site member engagement activities as needed, such as in-person member meetings, handling lobby calls at a retail or care center location, etc. (subject to change).
14. Other duties as assigned.
Job Requirements:
Alignmenthealthcare · Remote