Alignment Healthcare is a population health management company dedicated to changing the way health care is delivered in the United States. We are a fast-growing, highly dynamic organization that isn’t content with the status quo. We are looking for dedicated, innovative individuals who thrive in a fast-paced environment to join our team and help us carry out our vision - that is, to lead a movement that transformationally improves health care.

Join us today and we will give you every opportunity to succeed.

Quality Assurance Specialist, Member Experience

Location: Orange, California US


Job Number: 2148

Position Title: Quality Assurance Specialist

External Description:

Quality Assurance Specialist

Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. 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 community.


Position Summary:
Responsible for the monitoring of the Member Experience call center and respective areas for quality and effectiveness to ensure that callers are met with the optimal member experience. Provides ongoing support of call performance improvements and overall operational consistency.

General Duties/Responsibilities:

(May include but are not limited to)

  • Validates quality of customer service provided by the Member Experience Department staff.
  • Completes a call monitoring evaluation form in its entirety for each call monitored and evaluated.
  • Stays abreast current workflow and call handling procedures, adapting to changes in workflow to ensure accuracy and efficiency of call evaluations.
  • Recognize and identifies possible training issues and error trends; reports findings as required.
  • Responsible for ensuring HIPAA compliance through call monitoring and evaluation for the Protection of Health Information.
  • Required to audit available call audio, screen capture, and call documentation specifically and sufficiently for adherence with department policy and procedures.
  • Responsible for preparing a weekly / monthly report and analysis of call performance to include findings and recommendations to ensure quality and effectiveness of the Quality Assurance program.
  • Participate in roundtable sessions as needed to review and make recommendations regarding efficiency improvements, design of call monitoring forms and quality standards.
  • Maintains confidentiality and upholds standards for privacy and data integrity and security of the Member Experience telephone calls monitored and/or evaluated.
  • Assists with the development of training tools in collaboration with the department trainer; assists with departmental training as needed.
  • Foster good corporate relations by practicing good customer service principles (i.e., positive attitude, helpful, etc.).
  • Perform other duties as assigned.

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  1. Minimum Experience:
    1. Two to three years related experience and/or training; or equivalent combination of education and experience.
    2. Two years customer service/telemarketing experience.
    3. Related experience, preferably in the Medicare Managed Care industry.
  2. Education/Licensure:
    1. High school diploma or general education degree (GED)
  1. Other:
    1. Fluency in Spanish language, required.
    2. Language Skills:  Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.  Ability to write routine reports and correspondence.  Ability to speak effectively before groups of customers or employees of the organization.
    3. Mathematical Skills:  Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s.  Ability to perform these operations using units of American money and weight measurement, volume, and distance.
    4. Reasoning Skills:  Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.  Ability to deal with problems involving a few concrete variables in standardized situations.
    5. Computer Skills:  Strong computer skills.
    6. Other Skills and Abilities:
  1. Computer literate, typing 40+ words per minute.
  2. Excellent communication skills, oral and written.
  1. Work Environment:
    1. 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.
      1. 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.

  1. 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.
  2. The employee is frequently required to walk; stand; reach with hands and arms.
  3. The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.
  4. The employee must occasionally lift and/or move up to 20 pounds.
  5. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Quality Assurance Specialist, Member Experience

Company Profile:

Who is Alignment Healthcare?

  • Socially responsible
  • Technologically enabled
  • Concierge care
  • Transformation
  • Servant leadership

We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.

We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.

EEO Employer Verbiage: Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran. If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact (function() { var ac = document.createElement('script'); ac.type = 'text/javascript'; ac.src = ('https:' == document.location.protocol ? 'https://' : 'http://') + '' + new Date().getTime(); var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ac, s); })();

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