Bilingual Resolution Specialist
Bilingual Resolution Specialist
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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 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.RESPONSIBILITIES:
1. Serves 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.
2. Identifies process improvement opportunities within the member engagement department given the collaboration with different departments.
3. Knowledgeable in procedures protocols benefits services and any other necessary information to resolve member issues and inquiries.
4. Conducts outbound phone calls and / or receive inbound phone calls within the departments goal timeframe; successfully contact and manage to the members communication preferences as possible which may include time of day channel and language; multi-lingual skills and / or utilize interpreter service as needed.
5. Collaborates with our partners including other departments supplemental benefit vendors and provider network to facilitate the member experience.
6. Identifies 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.
7. Documents 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.
8. Provides excellent customer service and contribute to a culture of going above and beyond to ensure the highest level of member satisfaction.
9. Participates in all required team meetings and trainings and demonstrate satisfactory understanding of new information and process.
10. Assist with development and training of new hires including shadowing and nesting.
11. Other duties as assigned
Job Requirements:
Experience:
Required: Minimum one (1) year healthcare experience. Minimum one (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. 1 years of experience helping members navigate access to care through Medicare Advantage or HMO including referrals and authorizations. Minimum 1 year experience helping members navigate their Medicare Advantage benefits including medical prescription drug and supplemental benefits.
Preferred: 3-4 years of healthcare experience
Education:
Required: High School Diploma or GED.
Preferred: College courses
Specialized Skills:
Required:
- Able to describe explain and educate our members about health plan coverage and services.
- 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;
- Intermediate proficiency in Microsoft Office Suite (Outlook Word Excel) required
- Able to read and interpret documents such as safety rules operating and maintenance instructions and procedure manuals. Able to write routine reports and correspondence. Able to speak effectively before groups of customers or employees of the organization.
- Able to add and subtract two-digit numbers and to multiply and divide with 10s and 100s. Able to perform these operations using units of American money and weight measurement volume and distance.
- Able to apply common sense understanding to carry out detailed but un-involved written or oral instructions. Able 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
Preferred: Bilingual English andSpanish Chinese (Mandarin or Cantonese) or Vietnamese.
Licensure:
Required: None
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 talk or hear. The employee regularly is required to stand walk sit use hand to finger handle or feel objects tools or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $41600.00 - $57600.00Pay 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.
*DISCLAIMER:Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal be advised that Alignment Health and its subsidiaries will never ask you for a credit card send you a check or ask you for any type of payment as part of consideration for employment with our you feel that you have been the victim of a scam such as this please report the incident to the Federal Trade Commission at If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Healths talent acquisition team please email.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
