Job Details
Overview of the Role:
Alignment Health is seeking a passionate, customer service oriented, and motivated remote member experience lead to join the member services team. As a member experience lead, you will be a subject matter expert in the health care experience our members navigate daily. The lead will work alongside and conduct inbound and / or outbound member calls while concurrently role will empower and accelerate the performance of their team unit. As a member experience lead, you get to support team members with obtaining, maintaining, and enhancing the skills and training needed to provide excellent service to Alignment Health members. You will do so through daily performance monitoring as it pertains to production, quality, and service to ensure that company goals and departmental metrics are met.
Responsibilities:
* Be knowledgeable in procedures, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries
* Serve as a "subject matter expert" to support assigned team with day-to-day questions
* Lead any specific projects, products, regions, or other specializations as assigned, including complex or VIP member issues
* Answer incoming member phone calls within the department's goal time frame, and conducting outbound member phone calls in accordance with the department's productivity metrics and goals
* Address complaints against the health plan and its contracted facilities according to applicable complaint or grievance procedure.
* Assist in defining and monitoring performance and productivity standards
* Assist with the onboarding of entry level staff including but not limited to 'nesting' and quality assurance of live call monitoring during the training period as required
* Collaborate with the trainer and quality assurance (QA) specialist in identifying training needs; participate in regular meetings with management to report call trends and identify opportunities for team improvement
* Assist with the daily process of all members regular and retro PCP transfers, ensuring that 'supervisor' approval is appropriate according to workflow
* Assist with monitoring attendance and schedule adherence
* Maintain confidentiality and uphold standards for privacy, data integrity, and security
* Encourage a spirit of cooperation, teamwork, and accountability among all department employees
Supervisory Requirements:
* Support the oversight of the day-to-day operations and performance of the call agents.
* Assist with the supervisory responsibilities of planning, assigning, and monitoring work.
* Assist in the rewarding and disciplining of assigned employees as needed or required.
* Address complaints and resolve problems as necessary.
Required Skills and Experience:
* Minimum 3 years' customer service experience required.
* High school diploma or general education degree (GED); and three to five years related experience and / or training; or equivalent combination of education and experience required.
* Knowledge of Medicare Managed Care Plans required
* Previous lead experience or similar relevant experience required.
* Bilingual English / Spanish preferred
* Language Skills: 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.
* Mathematical Skills: Able to add and subtract two-digit numbers and to multiply and divide with 10's and 100's. Able to perform these operations using units of American money and weight measurement, volume, and distance.
* Reasoning Skills: Able to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Able to deal with problems involving a few concrete variables in standardized situations.
* Strong computer proficiency.
* Excellent written and verbal communication skills.
* Excellent telephone techniques.
* Excellent data entry.
* Strong organizational skills.
* Able to type minimum 40 words per minute (WPM) using 10-key by touch.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate.
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.
* While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
* The employee is frequently required to walk; stand; reach with hands and arms.
* The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.
* The employee must occasionally lift and/or move up to 20 pounds.
* Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Pay Range $43,500.00 - $52,000.00 annually