Bilingual Spanish Claims Resolution Specialist

alignmenthealthcare; United States; Remote; USD 28,000 - 34,000; Full time

Job summary

Alignment Health is seeking a bilingual Spanish Resolution Specialist to join the member engagement team. You will intake complex member cases and provide prompt resolution, reducing turnaround time and improving resolution quality.

You will address escalations related to authorizations, claims, and provider network issues while serving diverse stakeholders. The role emphasizes data accuracy, adherence to processes, and collaboration across departments to enhance member experience.

Qualifications

• 1+ year healthcare experience or training; 3-4 years preferred.
• 1+ year outbound call center experience or equivalent problem-solving in inbound calls.
• Experience helping members navigate Medicare Advantage/HMOs, referrals and authorizations.
• Experience with Medicare Advantage benefits including medical, prescription drug, and supplemental benefits.

Responsibilities

• Serve as a subject matter expert in escalated member calls (authorizations, claims, provider network issues) and resolve escalations based on healthcare processes.
• Identify process improvement opportunities within the member engagement department through collaboration with different departments.
• Communicate necessary information to resolve member issues and inquiries, maintaining data accuracy across systems.
• Make outbound calls or receive inbound calls within established timeframes, accommodating member communication preferences and language needs; use interpreter services if needed.
• Collaborate with partners, departments, vendors, and networks to improve member experience and identify care-gap opportunities; connect members to appropriate programs.

Skills

Healthcare experience

Outbound calls

Bilingual English/Spanish

Medicare Advantage knowledge

Education

High school diploma or GED

Tools

Microsoft Office

Job description

Alignment Health is seeking a bilingual Spanish Resolution Specialist to join the member engagement team. You will intake complex member cases and provide prompt resolution, reducing turnaround time and improving resolution quality.

You will address escalations related to authorizations, claims, and provider network issues while serving diverse stakeholders. The role emphasizes data accuracy, adherence to processes, and collaboration across departments to enhance member experience.