Remote Customer Service Representative; Bilingual in Spanish

Remote Regional Concierge Navigator

Provides outreach and support to Alignment Health members, ensuring they have access to the care they deserve. Supports members in navigating through health care and benefits. Connects the dots between provider network, health plan operations, and supplemental vendors.

• Provides in-market, specialized member support in respective market or region.
• Conducts in-market member engagement including Welcome Calls, New Member Onboarding, JSA Scheduling, High Quality PCP and Provider Terms, Product/Vendor Changes, CAHPS Proxy, Disenrollment Quality Assurance, and Proactive Service Recovery.
• Conducts case follow-ups and quality member issue resolution for all cases assigned.
• Ensures members have access to PCP and specialists to coordinate care.
• Educates members on gaps in care and assists with scheduling provider appointments.
• Serves as the patient's liaison throughout the program lifecycle by addressing program-specific quality measures and adhering to company guidelines/standard operating procedures.
• Makes appropriate and timely patient appointments, reminders, and confirmations and mails letters and correspondence as needed.
• Places regular/consistent outreach to the patient.
• Communicates with PCP with any member updates and requests.
• Assists with obtaining medical records from any healthcare providers involved in care or hospitals.
• Helps members with any authorizations and referrals involved in their care plan.
• Resolves incoming calls concerning members’ eligibility, benefits, provider information, clinical, and pharmacy needs; coordinates membership changes such as member’s primary care physician and engages member proactively with their wellness plan options.
• Participates in on-site member engagement activities as needed, such as in-person member meetings, handling lobby calls at a retail or care center location, etc. (subject to change).
• Other duties as assigned.

• Minimum 1 year of customer service experience.
• High-volume inbound customer service experience, particularly for health plan or Medicare “Member Services” roles preferred.
• Telemarketing and/or member outreach experience preferred.
• Specialized experience in escalation or resolution units preferred.
• High School Diploma or GED required.
• Knowledge of ICD‑10 and CPT codes.
• Keyboard typing 40+ words per minute.
• Ability to help members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations.
• Excellent written and oral communication skills; ability to establish and maintain constructive relationships with diverse members, management, employees and vendors.
• Problem‑solving, organizational, and time‑management skills; ability to work in a fast‑paced environment.
• Bilingual (English/Spanish, English/Vietnamese, or English/Mandarin) preferred; fluency in Spanish, Korean, or Vietnamese a plus.

100% remote position. Regular communication, occasional lifting up to 10 pounds, close vision, adjust focus.

$44,790.00 – $67,185.00

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.