Regional Concierge Navigator

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 serve. In 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 Concierge Navigator Advocate provides outreach and support to ensure all our members have access to the care they deserve. You will navigate our members through their health care and benefits, and connect the dots between our provider network, health plan operations, and supplemental vendors. You will be alongside our members every step of the way to ensure they are never alone in their healthcare journey. This is a role for a passionate and experienced customer service representative who understands the meaningful contribution they make to our members’ healthcare outcomes.

GENERAL DUTIES/RESPONSIBILITIES (MAY INCLUDE BUT ARE NOT LIMITED TO):
1.    Demonstrates understanding of procedures, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries; serve as a “subject matter expert” in the health care experience that our members navigate daily
2.    Conducts member outreach phone calls and/or receiving inbound phone calls within the department’s goal timeframe; manage to the member’s communication preferences as possible, which may include time of day, channel, and language; utilize interpreter service as needed
3.    Collaborates with our partners – including but not limited to other departments, supplemental benefit vendors, and provider network – to facilitate the member experience
4.    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
5.    Responsible for real-time documentation and timely wrap-up to support outcomes reporting in all systems/applications as required; must enter member demographics and information with accuracy and attention to detail, i.e. feel responsibility for the quality of our organizational data
6.    Excels in customer service and contribute to a culture of going “above and beyond” to ensure the highest level of member satisfaction
7.    Participates in all required team meetings and trainings, and exhibit satisfactory understanding of new information and process
8.    Supports other projects and duties as assigned by Management

Experience:

• Required: Minimum 1 year of experience helping members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations. Minimum 1 year of experience helping members navigate their Medicare Advantage benefits including medical, prescription drug, and supplemental benefits. Minimum one year of 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

Education:

• Required: High School Diploma or GED.

Specialized Skills:

• Required:

• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.

• 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.

• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;

• 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.

• Reasoning Skills: Ability to apply common sense understanding to carry out detailed, but un-involved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.

• Problem-Solving Skills:  Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.

• Report Analysis Skills:  Comprehend and analyze statistical reports.

• Preferred:

• Bilingual English/Spanish, or Vietnamese, Chinese (Mandarin), Korean

• Independently motivated self-starter who can prioritize work assignments and make every day a productive day

• Team player willing to help and support colleagues, and do their part to support us all reaching our organizational goals

• Natural “teacher” with the ability to learn plans and describe/explain/educate healthcare coverage and services to our members

Other:

• May be requested to be available to work full-time and over-time through the Annual Enrollment Period (Oct-Dec) and Open Enrollment Period (Jan-Mar)

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.

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 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. 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: $35,712.00 - $53,568.00

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 careers@ahcusa.com.

Salary : $35,712 - $53,568