Member Experience Lead

Location: Orange, California US

Notice

This position is no longer open.

Job Number: 3037

Workplace Type:

Position Title: Member Experience Lead

External Description:

MEMBER SERVICES UNIT LEAD

 

 

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.

 

 

Summary

The Member Experience Lead is a subject matter expert in the health care experience our members navigate daily. This ‘working’ role supports the inbound and/or outbound call experience while also assisting their experience team in obtaining proper plan information for our members, internal staff, and providers. The Lead assists in ensuring team members possess the skills and training necessary through daily performance monitoring as it pertains to the production, quality, and service to ensure that company goals and departmental metrics are met.

 

Essential Duties and Responsibilities

Essential duties and responsibilities include but are not limited to:

 

  1. Possess the knowledge 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-today questions, training, etc.,
  1. Assists in defining and monitoring performance and productivity standards specific to those systems that must be in place to serve Alignment Healthcare’s enrolled population.
  2. Assists with the onboarding of entry level staff including but not limited to ‘nesting’ and QA of live call monitoring during the training period as required.
  3. Collaborate with the Trainer and QA Specialist in identifying training needs for the development of training programs with direct effect towards the department.
  4. Assists with the daily process of all member regular and retro PCP transfers, ensuring that ‘supervisor’ approval is appropriate according to workflow.
  5. Assists with monitoring attendance and schedule adherence, that staff answer the incoming queue calls within the goal marks set.
  6. Assumes a ‘working’ role assisting with answering incoming member phone calls within the department’s goal time frame.
  7. Assigned complex or VIP member issues or special projects as required.
  8. Respond to complaints against the health plan and its contracted facilities by utilizing the departments Complaint / Grievance Policy and Procedure.
  9. Make all attempts to resolve all member dis-enrollment / cancellation requests, complaint / grievances, and assist the member with their questions or concerns and following up as appropriate.
  10. Maintains confidentiality and upholds standards for privacy and data integrity and security of the Member Services Representatives telephone calls monitored and/or evaluated.
  1. Encourages a spirit of cooperation, teamwork and accountability among all department employees.
  1. Performs other duties as assigned.

 

 

 

Supervisory Responsibilities

Supports the oversight of the day-to-day operations and performance of the Member Experience Agents. Assists with the supervisory responsibilities of planning, assigning, and monitoring work; assisting in the rewarding and disciplining of assigned employees as needed or required. Addresses complaints and resolves problems as they pertain to, as necessary.

Qualifications

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. Education and/or Experience:  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.
  2. Certificates, Licenses, Registrations:  None required.
  3. Other Qualifications: 
  4.  
    1. Knowledge of Medicare Managed Care Plans required.
    2. Three to five years customer service experience required.
    3.  Previous Lead experience required, or similar capacity.
    4. Bi-lingual (English/Spanish) preferred.

Skills and Abilities

 

  1. 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.
  2. 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.
  3. 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.
  4. Computer Skills:  Strong computer skills.
  5. Other Skills and Abilities:
  6.  
    1. Excellent communication skills.
    2. Strong writing skills
    3. Excellent telephone techniques.
    4. Excellent data entry.
    5. Strong organizational skills.
    6. Type 40+ words per minute.
    7. Experience with 10-key by touch. 

Physical Demands

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: Member Experience Lead

Company Profile:

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

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 information. Please 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 company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].