Remote Temporary Regional Concierge Navigator

About Alignment Health

Alignment Health is revolutionizing conventional health care, dedicated to serving seniors and those most in need: the chronically ill and frail. Our mission is to put the senior first, powered by a team of passionate, caring individuals. We foster a fast-growing environment with ample room for innovation and professional development. Working at Alignment Health means engaging in work that truly matters, changing and saving lives.

Role Overview: Remote Temporary Regional Concierge Navigator

The Remote Temporary Regional Concierge Navigator provides essential outreach and support to all members, ensuring seamless access to deserved care. This role helps members navigate their healthcare journey and benefits, connecting vital dots between our provider network, health plan operations, and supplemental vendors. You will maintain deep knowledge of member needs in your assigned market, offering unwavering support to ensure members never feel alone and receive the highest level of coordinated care. This position also lays the groundwork for ongoing member support and requires familiarity with assigned markets to contribute meaningfully to members' healthcare outcomes.

General Duties/Responsibilities

• Provides in-market, specialized member support within a specific 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.
• Manages case follow-ups and ensures quality member issue resolution for all assigned cases.
• Ensures members have access to PCPs and specialists for coordinated care.
• Educates members on gaps in care and assists with scheduling provider appointments.
• Serves as the patient's liaison throughout the program lifecycle, addressing quality measures and adhering to company guidelines.
• Makes appropriate and timely patient appointments, reminders, and confirmations, and handles necessary correspondence.
• Maintains regular and consistent outreach to patients.
• Communicates member updates and requests with PCPs.
• Assists with obtaining medical records from healthcare providers and hospitals.
• Helps members with authorizations and referrals for their care plan.
• Resolves incoming calls regarding members’ eligibility, benefits, provider information, clinical, and pharmacy needs.
• Coordinates membership changes, such as primary care physician, and proactively engages members with wellness plan options.
• Participates in on-site member engagement activities as needed, including in-person meetings or handling lobby calls at retail/care centers (subject to change).
• Performs other duties as assigned.

Experience Requirements

• Required: Minimum 1 year of customer service experience.
• Preferred: High-volume inbound customer service experience, particularly in health plan or Medicare “Member Services” roles.
• Preferred: Telemarketing and/or member outreach experience.
• Preferred: Specialized experience in escalation or resolution units.

Education

• Required: High School Diploma or GED.

Specialized Skills

• Required: Knowledge of ICD-10 and CPT codes.
• Required: Keyboard typing 40+ words per minute.
• Required: Ability to help members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations.
• Required: Ability to communicate positively, professionally, and effectively; provide leadership, teach, and collaborate with others.
• Required: Effective written and oral communication skills; ability to establish and maintain constructive relationships with diverse members, management, employees, and vendors.
• Language Skills: Ability to read and interpret documents, write routine reports, and speak effectively before groups.
• Reasoning Skills: Ability to apply common sense to follow detailed instructions and deal with concrete variables in standardized situations.
• Mathematical Skills: Ability to perform mathematical calculations and simple statistics correctly.
• Problem-Solving Skills: Effective problem-solving, organizational, and time management skills in a fast-paced environment.
• Required Language: English/Vietnamese.

Licensure

• Required: None.

Work Environment & Physical Functions

The work environment characteristics and physical demands described are representative of those encountered by an employee. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing duties, the employee regularly talks or hears, stands, walks, sits, uses hands, handles objects, and reaches with arms. The employee frequently lifts up to 10 pounds. Specific vision abilities include close vision and ability to adjust focus.

Key skills/competency

• Customer Service
• Healthcare Navigation
• Member Engagement
• Care Coordination
• Medicare Advantage
• HMO
• ICD-10
• CPT Codes
• Problem Solving
• Communication