Hybrid-Customer Experience Lead

Alignment Healthcare•Orange, CA

21h•Hybrid

About The Position

Alignment Health is committed to transforming healthcare for seniors, especially the chronically ill and frail. The company fosters a passionate and caring team dedicated to putting seniors first, offering ample opportunities for growth and innovation. The Member Experience & Engagement Lead acts as a subject matter expert in the healthcare experience, supporting inbound and outbound call operations and enhancing team performance. This role involves daily monitoring of team members' production, quality, and service to ensure departmental metrics and company goals are met.

Requirements

Minimum three (3) years of customer service experience
High School Diploma or GED
Knowledge of Medicare Managed Care Plans required
Type 40+ words per minute and ability/experience with 10-key by touch
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors
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 uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations
Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution
Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment
No licensure required

Nice To Haves

5+ years customer service experience
Healthcare experience
Previous Lead experience
College courses
Bi-lingual (English/Spanish) preferred

Responsibilities

Acts as the subject matter expert for procedures, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries
Leads any specific projects, products, regions, or other specializations as assigned, including complex or VIP member issues
Assumes the tier two role that includes answering incoming member phone calls within the department’s goal time frame, and conducting outbound member phone calls in accordance with the department’s productivity metrics and goals
Address complaints against the health plan and its contracted facilities according to applicable complaint or grievance procedure
Assists in defining and monitoring performance and productivity standards
Assists with the onboarding of entry level staff including but not limited to ‘nesting’ and quality assurance of live call monitoring during the training period as required
Collaborates with the Trainer and QA Specialist in identifying training needs; participate in regular meetings with management to report call trends and identify opportunities for team improvement
Maintains confidentiality and upholds standards for privacy, data integrity, and security
Encourages a spirit of cooperation, teamwork, and accountability among all department employees
Performs other duties as assigned