Remote Bilingual Spanish 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 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 Resolutions Specialist provides member issue resolution managing and resolving healthcare insurance claims in a timely and accurate manner.

This role requires solid analytical skills, knowledge of healthcare insurance policies, and a commitment to providing exceptional service to policyholders, healthcare providers, and internal stakeholders.

Overview of the Role

Alignment Health is seeking a bilingual Spanish resolution specialist to join the member engagement team to provide member issue resolution. As a resolution specialist, you will intake complex member cases and provide prompt and satisfactory resolution. You will be dedicated to decreasing turnaround time, improving the quality of resolution, and managing barriers to resolution as part of process improvement and Voice of the Customer (VoC).

Schedule

• Monday through Friday
• Between 8:00am - 5:00pm Pacific Time
• Between 9:00am - 6:00pm Mountain Time
• Between 10:00am - 7:00pm Central Time
• Between 11:00am - 8:00pm Eastern Time

No Time Off Approved During

• No time off is permitted during the first (5) week training period.
• Annually during entire month of January due to it being the busiest time of the year (no exceptions)

Responsibilities

• Serve as a "subject matter expert" in escalated member calls (authorizations, claims, provider network issues) and be able to resolve these escalations based on level of understanding / experience of healthcare processes and protocols.
• Identify process improvement opportunities within the member engagement department given the collaboration with different departments.
• Knowledgeable in procedures, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries.
• Conduct outbound phone calls and / or receive inbound phone calls within the department's goal timeframe; successfully contact and manage to the member's communication preferences as possible, which may include time of day, channel, and language; multi-lingual skills and / or utilize interpreter service as needed.
• Collaborate with our partners, including 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.
• Document real-time and conduct timely wrap-up to support outcomes reporting in all systems / applications by entering member demographics and information with accuracy and pay attention to detail, focusing on data integrity in support of quality organizational data.
• Meet and exceed individual and team goals by submitting activity reports in the format and frequency required. Provide excellent customer service and contribute to a culture of going "above and beyond" to ensure the highest level of member satisfaction.
• Participate in all required team meetings and trainings and demonstrate satisfactory understanding of new information and process.
• Adhere to all applicable attendance and productivity policies.
• Assist with development and training of new hires including shadowing and nesting.

Required Skills and Experience

• Minimum (1) year healthcare experience and / or training required; 3-4 years of healthcare experience / training required.
• Minimum (1) year 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.
• Experience helping members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations.
• Experience helping members navigate their Medicare Advantage benefits including medical, prescription drug, and supplemental benefits.
• High school diploma or general education degree (GED); or equivalent combination of education and experience.
• Intermediate proficiency in Microsoft Office Suite (Outlook, Word, Excel) required Bilingual English and Spanish, Chinese (Mandarin or Cantonese), or Vietnamese.
• Independent, motivated, self-starter who can prioritize work assignments and make every day a productive day.
• Team player willing to help