Concierge Navigator

Alignment Healthcare•Remote - CA, CA

10h•Remote

About The Position

Concierge Navigator- Advocate Position Summary: 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. Essential Duties and Responsibilities: Essential duties and responsibilities of the Concierge Navigator- Advocate include, but are not limited to: Be knowledgeable in 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 Responsible for conducting 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 Collaborate with our partners – including but not limited to other departments, supplemental benefit vendors, and provider network – to facilitate the member experience Identify 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 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 Responsible for meeting or exceeding individual and team goals, and for submitting activity reports in the format and frequency required Excel in customer service and contribute to a culture of going “above and beyond” to ensure the highest level of member satisfaction Must participate in all required team meetings and trainings, and exhibit satisfactory understanding of new information and process Adhere to all applicable attendance and productivity policies Support other projects and duties as assigned by Management Supervisory Responsibilities This job has no supervisory responsibilities.

Requirements

Experience helping members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations
Experience helping members navigate their Medicare Advantage benefits including medical, prescription drug, and supplemental benefits
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
Must be available to work full-time and over-time through the Annual Enrollment Period (Oct-Dec) and Open Enrollment Period (Jan-Mar)
High school diploma or general education degree (GED); two to three years related experience and/or training; or equivalent combination of education and experience.
None required
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.
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.
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.
Strong computer skills.
Computer literate, typing 40+ words per minute.
Excellent communication skills, oral, and written.

Nice To Haves

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
Genuine passion for customer service

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” in the health care experience that our members navigate daily
Responsible for conducting 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
Collaborate with our partners – including but not limited to other departments, supplemental benefit vendors, and provider network – to facilitate the member experience
Identify 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
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
Responsible for meeting or exceeding individual and team goals, and for submitting activity reports in the format and frequency required
Excel in customer service and contribute to a culture of going “above and beyond” to ensure the highest level of member satisfaction
Must participate in all required team meetings and trainings, and exhibit satisfactory understanding of new information and process
Adhere to all applicable attendance and productivity policies
Support other projects and duties as assigned by Management