Regional Concierge Navigator (Bilingual in Spanish)

E2E Alignment Healthcare USA, LLC; California; Presencial; USD 44 790 - 67 185; Tempo integral

Resumo da oferta

E2E Alignment Healthcare USA, LLC is seeking a Remote Regional Concierge Navigator. This role is centered on providing specialized support to members, particularly seniors and the chronically ill, ensuring they receive the right care and assistance.

The position includes responsibilities such as coordinating care, conducting member engagement, and ensuring accessibility to healthcare services. Ideal candidates will have customer service experience, particularly in health plan or Medicare roles, and must possess a High School Diploma or GED.

Qualificações

• Minimum 1 year of customer service experience.
• High-volume inbound customer service experience, particularly for health plan or Medicare member services roles.
• Ability to help members navigate access to care through Medicare Advantage or HMO.

Responsabilidades

• Provide specialized member support in the assigned market or region.
• Conduct member engagement activities, including onboarding and proactive service recovery.
• Ensure members have access to PCP and specialists to coordinate care.

Conhecimentos

Customer service experience

Health plan member services

Telemarketing experience

Knowledge of ICD-10 and CPT codes

Bilingual proficiency

Formação académica

High School Diploma or GED

Descrição da oferta de emprego

Remote Regional Concierge Navigator

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. We build a team of passionate, experienced people dedicated to putting the senior first and 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.

Responsibilities

• Provides in‑market, specialized member support in the assigned market or region.
• Conducts in‑market member engagement, including Welcome Calls, New Member Onboarding, JSA Scheduling, High Quality PCP and Provider Terms, Product/Vendor Changes, CAHPS Proxy, Disenrollment Quality Assurance, and Proactive Service Recovery.
• Conducts case follow‑ups and resolves quality member issues for all cases assigned.
• Ensures members have access to PCP and specialists to coordinate care.
• Educates members on gaps in care and assists with scheduling provider appointments.
• Serves as the patient’s liaison throughout the program life cycle, addressing program‑specific quality measures and adhering to company guidelines and standard operating procedures.
• Schedules appointments, sends reminders, confirms appointments, and mails letters and correspondence as needed.
• Places regular and consistent outreach to patients.
• Communicates with PCPs regarding member updates and requests.
• Assists with obtaining medical records from any healthcare providers involved in care or hospitals.
• Helps members with authorizations and referrals involved in their care plan.
• Resolves incoming calls concerning members’ eligibility, benefits, provider information, clinical, and pharmacy needs; coordinates membership changes such as primary care physician changes and proactively engages members with wellness plan options.
• Participates in on‑site member engagement activities as needed, such as in‑person meetings and handling lobby calls at a retail or care center location.
• Other duties as assigned.

Qualifications

• Experience
  • Minimum 1 year of customer service experience.
  • High‑volume inbound customer service experience, particularly for health plan or Medicare member services roles.
  • Telemarketing and/or member outreach experience preferred.
  • Specialized experience in escalation or resolution units preferred.
• Education
  • High School Diploma or GED required.
• Specialized Skills
  • Knowledge of ICD‑10 and CPT codes.
  • Keyboard typing 40+ words per minute.
  • Ability to help members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations.
  • Positive, professional, and effective communication skills with diverse members, management, employees and vendors.
• Language Skills
  • Ability to read, interpret and write routine reports and correspondence.
  • Preferred bilingual experience: English/Spanish, English/Vietnamese, or English/Mandarin. Fluency in written and verbal Spanish, Korean, or Vietnamese also considered a plus.
• Reasoning Skills
  • Application of common sense in carrying out detailed written or oral instructions.
  • Ability to deal with problems involving a few concrete variables in standardized situations.
• Mathematical Skills
  • Ability to perform basic mathematical calculations and simple statistics correctly.
• Problem‑Solving Skills
  • Effective problem solving, organizational and time management skills; ability to work in a fast‑paced environment.
• Preferred
  • Bilingual proficiency and fluency in additional languages as mentioned above.
• Licensure
  • No specific licensure required.

Work Environment

100% remote. The work environment characteristics described here represent those encountered while performing the essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical Demands

Regularly required to talk or hear; stand, walk, sit, use hands to finger objects, tools, or controls; reach with hands and arms. Frequently lifts and/or moves up to 10 pounds. Requires close vision and ability to adjust focus.

Pay Range

$44,790.00 - $67,185.00

Equal Opportunity Statement

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.

Anti‑Phishing Notice

Please beware of recruitment phishing scams. Alignment Health and its subsidiaries will never ask for a credit card, send a check, or ask for any payment during the hiring process. If you suspect a scam, report it to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. To verify the legitimacy of an email from our talent acquisition team, contact [e-mail].