Member Experience Associate 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.

MEMBER EXPERIENCE ASSOCIATE

Summary

The Member Experience Associate assists plan members with their concerns or complaints and provides the necessary information and education to resolve concerns. Focusing on delighting members by exceeding their expectations and paying attention to detail by acting as a single point of contact to deliver needed care for the best member experience by acting as the liaison between the member and all other member facing departments to obtain first call resolution.

Essential Duties and Responsibilities

Essential duties and responsibilities include, but are not limited to:

1. Seeks and understands the needs and expectation of internal and external customers in a friendly, positive and outgoing manner.

2. Explains the plan’s procedures, protocols, benefits, services, and any other necessary information to the members who telephone or visit the Member Services Department.

3. Goes above and beyond to address all of the member’s inquiries and needs, focusing on first call resolution.

4. Ensures timely and adequate follow up to ensure member is satisfied with the outcome and resolution of open or pending items until completely resolved.

5. Facilitate member requests for changes with network provider changes, transportation requests, appointment scheduling, or any other member request for assistance as appropriate.

6. Answer all incoming member phone calls within the department’s goal timeframe.

7. Documents every incoming call during the course of the call with pertinent details (i.e., caller name, contact info, reason for call, action taken, resolution, etc.,) to ensure quality.

8. Make all attempts to resolve all member disenrollment/cancellation requests, complaint/grievances, escalating access to care issues to Network and UM to facilitate the member’s access to care issue.

9. Assist with Member Outreach programs and implementations as needed.

10. Foster good corporate relations by practicing good customer service principles (i.e., positive attitude, helpful, etc.).

11. Perform other duties as assigned by Department Management.

Supervisory Responsibilities

This job has no supervisory responsibilities.

Qualifications

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.

1. Education and/or Experience: High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.

2. Certificates, Licenses, Registrations: None required.

3. Other Qualifications:

a. Two years customer service/telemarketing experience; or

Medical front office experience.

Alignment Healthcare

Job Description

DATE: May 2015 JOB TITLE: Member Experience Associate

DEPARTMENT: Member Services

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

c. Bilingual (English/Spanish), preferred.

Skills and Abilities

1. 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.

2. Mathematical Skills: Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s. Ability to perform these operations using units of American money and weight measurement, volume, and distance.

3. 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.

4. Computer Skills: Strong computer skills.

5. Other Skills and Abilities:

a. Computer literate, typing 40+ words per minute.

b. Excellent communication skills, oral and written.

Physical Demands

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.

1. 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.

2. The employee is frequently required to walk; stand; reach with hands and arms.

3. The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.

4. The employee must occasionally lift and/or move up to 20 pounds.

5. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Working 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.

1. The noise level in the work environment is usually moderate.