Remote Bilingual Spanish Resolution Specialist

Alignment Health; United States; Remote; USD 42,000 - 58,000; Full time

Job summary

Alignment Health is seeking a Remote Bilingual Spanish Resolution Specialist to join the member engagement team. This role handles escalated member cases and provides prompt resolution across authorizations, claims, and network issues while leveraging bilingual language skills.

You will work to reduce turnaround time, improve resolution quality, and support process improvements with VoC initiatives; training occurs during a busy enrollment period.

Qualifications

• Minimum 1 year healthcare experience; 3-4 years preferred.
• Minimum 1 year outbound call center experience; inbound with escalation also acceptable.
• Experience helping members navigate Medicare Advantage or HMO referrals and authorizations.
• Experience aiding members with Medicare Advantage benefits (medical, prescription drug, supplemental).
• High school diploma or GED or equivalent combination of education and experience.
• Intermediate proficiency in Microsoft Office Suite.

Responsibilities

• Serve as a subject matter expert in escalated member calls and resolve escalations based on healthcare processes and protocols.
• Identify opportunities for process improvement within the member engagement department.
• Conduct outbound and inbound calls, manage member communication preferences and language needs; use interpreter services as needed.
• Collaborate with partners and other departments to facilitate the member experience.
• Document demographics and information accurately to support outcomes reporting; ensure data integrity.
• Meet and exceed individual and team goals by submitting activity reports on schedule.
• Participate in meetings and trainings; adhere to attendance and productivity policies.
• Assist with development and training of new hires including shadowing and nesting.

Skills

Bilingual English/Spanish

Customer service

Microsoft Office

Problem solving

Education

High school diploma or GED

Tools

Microsoft Excel

CRM systems

Job description

Alignment Health is seeking a Remote Bilingual Spanish Resolution Specialist to join the member engagement team. This role handles escalated member cases and provides prompt resolution across authorizations, claims, and network issues while leveraging bilingual language skills.

You will work to reduce turnaround time, improve resolution quality, and support process improvements with VoC initiatives; training occurs during a busy enrollment period.