Disenrollment Specialist at Alignment Healthcare USA, LLC in Orange, California

Job Description:

Overview of the Role:

Alignment Health is seeking a passionate, attentive, and customer-service oriented disenrollment specialist to join the member retention team. As a disenrollment specialist, you get to support our members with disenrollment requests and provide related quality assurance. If you are genuinely interested in the needs of members, committed to proactively addressing member needs, a solution seeking problem solver, and can effectively resolve call escalations, we're looking for YOU!

Schedule:

• Monday through Friday (Somewhat flexible start time)

8:00am - 5:00pm Pacific Time
9:00am - 6:00pm Mountain Time
10:00am - 7:00pm Central Time
11:00am - 8:00pm Eastern Time

• Voluntary overtime half-day on first / last Saturday of the month (month close), with commensurate overtime pay.
• Annually, must be willing and able to work over-time:


• October through December during Annual Enrollment Period (AEP)
• January through March during Open Enrollment Period OEP
• Participate in paid training for the first 2-3 weeks.

No Time Off Approved:

• Annually between Dec 9 - Jan 31 due to it being the business time of the year (no exceptions)

Responsibilities:

1. Serve as a "subject matter expert" in escalated member calls at risk of disenrollment and be able to resolve these escalations based on level of understanding/experience of healthcare, processes and protocols (i.e. authorizations, claims, provider network issues).
2. Identify process improvement opportunities within the Member Engagement department given the collaboration with different departments.
3. Meet and exceed monthly goals individual and team goals as assigned, submit activity reports in the format and frequency required.
4. Be knowledgeable in procedures, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries.
5. Conduct outbound phone calls and / or receive inbound phone calls within the department's goal timeframe; successfully contact and adapt to the member's communication preferences as possible, which may include time of day, channel, and language; multi-lingual skills and / or utilize interpreter service as needed.
6. Collaborate with our partners - including but not limited to other departments, supplemental benefit vendors, and provider networks - to facilitate the member experience.
7. Collaborate with the team by sharing best practices and participating in team meetings or training.
8. Provide outbound support for PCP / IPA terminations.
9. Provide information and assistance within the standards established by all applicable federal / state laws and regulations and health plan compliance.
10. Document real-time and conduct 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 and ensure high quality of our organizational data.
11. Excel in customer service and contribute to a culture of going "above and beyond" to ensure the highest level of member satisfaction.
12. Participate in team meetings and trainings, and exhibit satisfactory understanding of new information and process related to the company, health plan benefit packages, and Centers for Medicare and Medicaid Services (CMS)
13. Adhere to attendance and productivity policies.
14. Assist with the development and training of new hires including shadowing and nesting.

Required Skills and Experience:

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. Minimum of 1 year healthcare experience and / or training required; 2-4 years preferred.
2. Experience with Medi-Cal, Commercial, and Medicare Managed Care Plans and / or sales, customer service, or membership and eligibility.
3. Provide excellent customer service and comfortable being on phones.
4. Strong computer proficiency; Intermediate knowledge and experience with Microsoft Office Suite of products (Outlook, Excel, Word.)
5. Strong knowledge and understanding of the Medicare Managed Care Manual Chapter 2 - Medicare Advantage Enrollment and Disenrollment and Medicare Communications and Marketing Guidelines.
6. High school diploma or general education degree (GED); or equivalent combination of education and experience required.
7. Experience in sales and / or health plan disenrollment process preferred.
8. Bilingual English and Spanish or Vietnamese, Chinese (Mandarin or Cantonese), Korean preferred.
9. Sales license or completion of Alignment Health Plan sales certification a plus.
10. Experience helping members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations, medical prescription drug, and supplemental benefits preferred.
11. Independent self-starter who can effectively prioritize work assignments.
12. Team player who is willing to help and support colleagues and help the team in reaching organizational goals.
13. Natural "teacher" with the ability to learn plans and describe / explain / educate healthcare coverage and services to our members.
14. Genuine passion for customer service and member satisfaction
15. Flexible and adaptable with schedule depending on department needs.
16. Able to troubleshoot / problem solve.
17. Language Skills: Able to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Able to write routine reports and correspondence. Able to speak effectively before groups of customers or employees of the organization.
18. Mathematical Skills: Able to add and subtract two-digit numbers and to multiply and divide with 10's and 100's. Able to perform these operations using units of American money and weight measurement, volume, and distance.
19. Reasoning Skills: Able to apply common sense understanding to carry out detailed, but un-involved written or oral instructions. Able to deal with problems involving a few concrete variables in standardized situations.

Work Environment

1. 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.

1. 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.
2. 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: $41,600 - $50,000 ANNUALLY

Please note: This role is eligible for a monthly quality incentive bonus based on individual and team performance (subject to change.)

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