Bilingual Spanish Member Resolution Specialist

Alignment Healthcare USA, LLC in; Orange (CA); À distance; USD 42 000 - 58 000; Plein temps

Résumé du poste

Alignment Health is seeking a bilingual Spanish Resolution Specialist to join the member engagement team to resolve complex member issues and improve turnaround times. You will intake cases and provide prompt, satisfactory resolutions, leveraging knowledge of healthcare policies to support policyholders, providers, and internal stakeholders.

The role requires healthcare experience, outbound/inbound call handling, and multilingual communication, with training during the annual enrollment period.

Qualifications

• Minimum 1 year healthcare experience and/or training required; 3-4 years of healthcare experience/training preferred.

Responsabilités

• Serve as a subject matter expert in escalated member calls (authorizations, claims, provider network issues) and resolve escalations.
• Identify process improvement opportunities within the member engagement department.
• Be knowledgeable in procedures, protocols, benefits, services to resolve member issues and inquiries.
• Conduct outbound and inbound calls within the department’s goals and adapt to member communication preferences (time, channel, language).
• Collaborate with partners and other departments to facilitate the member experience.
• Identify care gaps and connect members to programs or services; determine eligibility and connect to provider or vendor.
• Document real-time updates and support outcomes reporting with accurate demographics in all systems.
• Meet and exceed team goals by submitting activity reports.
• Provide excellent customer service and contribute to a culture of going above and beyond.
• Participate in training and shadowing of new hires; adhere to attendance/productivity policies.

Connaissances

Bilingual English and Spanish

Customer service

Problem solving

Formation

High school diploma or GED

Outils

Microsoft Office Suite (Outlook, Word, Excel)

Description du poste

Alignment Health is seeking a bilingual Spanish Resolution Specialist to join the member engagement team to resolve complex member issues and improve turnaround times. You will intake cases and provide prompt, satisfactory resolutions, leveraging knowledge of healthcare policies to support policyholders, providers, and internal stakeholders.

The role requires healthcare experience, outbound/inbound call handling, and multilingual communication, with training during the annual enrollment period.