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Concierge Navigator - Advocate at Alignment Healthcare USA, LLC in Orange, California

Posted in Admin - Clerical 30+ days ago.

Type: Full-Time

Job Description:

Alignment Health 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 Health 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.

Position Summary: 

The Concierge Navigator Advocate provides outreach and support to ensure all our members have access to the care they deserve. You will navigate our members through their health care and benefits, and connect the dots between our provider network, health plan operations, and supplemental vendors. You will be alongside our members every step of the way to ensure they are never alone in their healthcare journey. This is a role for a passionate and experienced customer service representative who understands the meaningful contribution they make to our members’ healthcare outcomes. 

Essential Duties and Responsibilities:
(May include but are not limited to)

  • Be knowledgeable in procedures, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries; serve as a “subject matter expert” in the health care experience that our members navigate daily

  • Responsible for conducting member outreach phone calls and/or receiving inbound phone calls within the department’s goal timeframe; manage to the member’s communication preferences as possible, which may include time of day, channel, and language; utilize interpreter service as needed

  • Collaborate with our partners – including but not limited to other departments, supplemental benefit vendors, and provider network – to facilitate the member experience

  • 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

  • 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 responsibility for the quality of our organizational data

  • Responsible for meeting or exceeding individual and team goals, and for submitting activity reports in the format and frequency required

  • Excel in customer service and contribute to a culture of going “above and beyond” to ensure the highest level of member satisfaction

  • Must participate in all required team meetings and trainings, and exhibit satisfactory understanding of new information and process

  • Adhere to all applicable attendance and productivity policies

  • Support other projects and duties as assigned by Management

Supervisory Responsibilities
This job has no supervisory responsibilities.

Minimum Requirements

  1. Experience helping members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations

  2. Experience helping members navigate their Medicare Advantage benefits including medical, prescription drug, and supplemental benefits

  3. 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

  4. Must be available to work full-time and over-time through the Annual Enrollment Period (Oct-Dec) and Open Enrollment Period (Jan-Mar) 

Minimum 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); two to three years related experience and/or training; or equivalent combination of education and experience.

  2. Certificates, Licenses, Registrations: None required

  3. Other Qualifications – preferred, but not required:

  • Bilingual English/Spanish, or Vietnamese, Chinese (Mandarin), Korean

  • Independently motivated self-starter who can prioritize work assignments and make every day a productive day

  • Team player willing to help and support colleagues, and do their part to support us all reaching our organizational goals

  • Natural “teacher” with the ability to learn plans and describe/explain/educate healthcare coverage and services to our members

  • Genuine passion for customer service

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 un-involved 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:

  • Computer literate, typing 40+ words per minute.

  • Excellent communication skills, oral, and written.

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. 

  1. 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.

  2. 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.

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