Hybrid-Customer Experience Lead (Orange, CA)

Alignment Health; Orange (CA); Hybrid; USD 45,000 - 67,000; Full time

Job summary

Alignment Health in California is seeking a Hybrid Member Experience & Engagement Lead to guide the customer service team, shaping the member experience as they navigate benefits and services.

You will monitor performance, mentor staff, handle complex member issues, and collaborate with trainers to drive improvements while maintaining privacy and data security.

Qualifications

• Required: High School Diploma or GED.
• Preferred: College courses.

Responsibilities

• Acts as SME for procedures, benefits, services, and member inquiries.
• Leads projects, products, regions, or specializations, including VIP issues.
• Handles tier two calls within goal time frames and outbound calls per metrics.
• Addresses complaints about the health plan and facilities per procedures.
• Defines and monitors performance and productivity standards.
• Assists onboarding of entry level staff including nesting and QA.
• Collaborates with Trainer and QA to identify training needs and trends.
• Maintains confidentiality and upholds privacy and security standards.
• Encourages cooperation, teamwork, and accountability across the department.
• Performs other duties as assigned.

Skills

Medicare knowledge

Typing 40 wpm

Leadership

Communication

Math skills

Reasoning

Problem solving

Bilingual (English/Spanish)

Education

High School Diploma or GED

College courses

Job description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. 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 Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The hybrid Member Experience & Engagement Lead is a subject matter expert in the health care experience our members navigate daily. Supports the inbound and/or outbound call experience while also assisting and accelerating the performance of their team unit. The Lead helps ensure team members possess the skills and training necessary through daily performance monitoring as it pertains to production, quality, and service to ensure that company goals and departmental metrics are met.

• minimum of 1 to 2 days in the office a week.

General Duties/Responsibilities

• Acts as the subject matter expert for procedures, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries
• Leads any specific projects, products, regions, or other specializations as assigned, including complex or VIP member issues
• Assumes the tier two role that includes answering incoming member phone calls within the department’s goal time frame, and conducting outbound member phone calls in accordance with the department’s productivity metrics and goals
• Address complaints against the health plan and its contracted facilities according to applicable complaint or grievance procedure
• Assists in defining and monitoring performance and productivity standards
• Assists with the onboarding of entry level staff including but not limited to 'nesting' and quality assurance of live call monitoring during the training period as required
• Collaborates with the Trainer and QA Specialist in identifying training needs; participate in regular meetings with management to report call trends and identify opportunities for team improvement
• Maintains confidentiality and upholds standards for privacy, data integrity, and security
• Encourages a spirit of cooperation, teamwork, and accountability among all department employees
• Performs other duties as assigned

Experience

• Required: Minimum three (3) years of customer service experience.
• Preferred: 5+ years customer service experience. Healthcare experience. Previous Lead experience

Education

• Required: High School Diploma or GED.
• Preferred: College courses

Specialized Skills

• Required:
• Knowledge of Medicare Managed Care Plans required
• Type 40+ words per minute and ability/experience with 10-key by touch.
• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
• 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.
• 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.
• Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
• Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• Preferred: Bi-lingual (English/Spanish) preferred

Licensure

• Required: None

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.

The noise level in the work environment is usually moderate.

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 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.

Pay Range: $44,790.00 - $67,185.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.