Spanish-Speaking Member Resolution Specialist

Alignment Healthcare USA, LLC; Orange (CA); Remoto; USD 42.000 - 58.000; Tempo pieno

Descrizione del lavoro

Alignment Health USA, LLC is seeking a bilingual Spanish Resolution Specialist to join the member engagement team. You will intake complex member cases and provide prompt resolutions, focusing on reducing turnaround time and improving resolution quality.

You will collaborate with other departments and vendors to support member care gaps, document interactions, and ensure data accuracy across systems while delivering exceptional customer service.

Competenze

• Minimum 1 year healthcare experience; 3-4 years preferred.
• Minimum 1 year outbound call center experience; or inbound with problem-solving.
• Experience helping members navigate Medicare Advantage or HMO, including referrals and authorizations.
• Experience helping members navigate Medicare Advantage benefits including medical, prescription drug, and supplemental benefits.
• Intermediate proficiency in Microsoft Office Suite (Outlook, Word, Excel).
• Bilingual English and Spanish, Chinese (Mandarin or Cantonese), or Vietnamese.

Mansioni

• 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 in collaboration with other departments.
• Confer with members via outbound/inbound calls within the department’s timeframes and adapt to communication preferences.
• Collaborate with partners, including other departments and vendors, to facilitate the member experience.
• Document real-time and conduct timely wrap-ups to support outcomes reporting across systems with accurate data.
• Meet and exceed individual and team goals by submitting activity reports as required.

Formazione

High school diploma or GED

Strumenti

Microsoft Office

Descrizione del lavoro

Alignment Health USA, LLC is seeking a bilingual Spanish Resolution Specialist to join the member engagement team. You will intake complex member cases and provide prompt resolutions, focusing on reducing turnaround time and improving resolution quality.

You will collaborate with other departments and vendors to support member care gaps, document interactions, and ensure data accuracy across systems while delivering exceptional customer service.