Responsibilities
- Build caring connections with every member by always leading with empathy, patience, and respect, ensuring members feel heard, supported, and valued throughout every interaction.
- Own each member interaction end-to-end, taking accountability to resolve inquiries during the initial contact and ensuring clear follow-through when additional steps are required.
- Deliver exceptional service by consistently exceeding member expectations and reinforcing a culture focused on trust, compassion, and first-call resolution.
- Accurately respond to member inquiries regarding benefits, eligibility, services, policies, and procedures in a clear, confident, and member-friendly manner.
- Assist members with provider network and claim/reimbursement inquiries, benefit questions related to transportation, food, dental and other support services and needs, proactively identifying solutions and next steps.
- Answer incoming contacts within established service levels while always managing complex and sensitive situations with professionalism and care.
- Thoroughly document all member interactions, actions taken, and outcomes in real time to ensure accuracy, continuity of care and effective resolution.
- Proactively address member complaints, grievances, and disenrollment concerns with goal to resolve by listening for root causes, offering solutions, and escalating appropriately when needed.
- Support outbound outreach initiatives and service programs designed to improve engagement, education, and overall member experience.
- Represent Alignment Healthcare with integrity and positivity, modeling a serving-heart mindset and commitment to excellence in every interaction.
- Participate actively in ongoing coaching, feedback, and learning to continuously strengthen service skills and member advocacy.
Requirements
- 2+ years of customer service, contact center, or member support experience, preferably in healthcare and/or Medicare Advantage.
- High school diploma or GED required. College degree, Associate’s or Bachelor’s preferred or any equivalent combination of education and work experience.
- Demonstrated ability to use technology and follow detailed workflow instructions.
- Bilingual English/Mandarin (Read, Write, Speak).
- Minimum typing speed of 40 WPM.
- Proficient in navigating multiple systems simultaneously, including Microsoft Outlook, Word, Excel, CRM and Contact Center solutions.
- On camera presence for 100% Remote training, one on one, team and group meetings.
- Workspace must be free of distractions with the ability to maintain strict confidentiality and compliance with HIPAA regulations.
- Sufficient internet bandwidth and access to connect with Alignment’s systems during scheduled shift.
- Proper care and availability of technology equipment such as headsets, keyboard, to perform responsibilities without impact on operational and scheduled shift requirements.
- Clear, concise and warm verbal communication skills with the ability to explain complex information simply and compassionately and ability to document interactions accurately.
- Demonstrated empathy, patience, and respect when working with older adults and individuals with disabilities.
- Comfortable working in a culture of continuous coaching, feedback, and performance improvement to meet defined KPIs related to attendance, schedule adherence and quality.
- Ability to manage high call volumes while handling complex, emotionally sensitive interactions.
- Flexibility to work shifts to meet business needs.
Nice to Have
- Knowledge of Medicare Advantage, Medi-Cal, or managed care plans preferred.
- Strong problem-solving skills with a proactive, ownership-driven mindset.
- Organized, self-motivated, and comfortable working in a fast-paced environment.
Additional Information
- Hourly rate: $20 / $21 (CA & NY)
- Work must be conducted within the contiguous US.
- Must maintain HIPAA compliance and confidentiality.
- Must have sufficient internet bandwidth and proper technology equipment (headsets, keyboard, etc.).
- On-camera presence required for training and meetings.
- Background check required as part of pre-employment process.
- Flexibility to work shifts to meet business needs.
