Member Experience Associate (Temporary) at Alignment Healthcare USA, LLC in Orange, California

Job Description:

Who is Alignment Healthcare?

• Socially responsible


• Technologically enabled


• Concierge care


• Transformation


• Servant leadership

We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.

We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.

Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. 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 community.

Alignment Healthcare is seeking a passionate, highly-motivated, and detail-oriented member experience associate to join the member experience team in our Orange, CA office. The member experience associate will assist plan members with their concerns or complaints and provides the necessary information and education to resolve concerns.

General Duties and Responsibilities

(May include but are not limited to)

• 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.

Minimum Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum 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.

Education / Licensure

• 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).

Other

• Knowledge of Medi-Cal, Commercial, and Medicare Managed Care Plans.


• Bilingual (English / Spanish) preferred.


• 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.