Quality Retention Specialist
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Job Description
Quality Retention Specialist at Alignment Health supporting members' health care needs and disenrollment requests. Collaborating with various departments to enhance member experience in a customer-focused role.
Responsibilities:
- Supports our members in their disenrollment requests and related quality assurance.
- Acts in a customer-focused manner and is genuinely interested in the needs of our members.
- Address’ various customer-related needs and problem-solve to effectively resolve call escalations.
- Serves as a “subject matter expert” in escalated member calls at risk of disenrollment.
- Identifies process improvement opportunities within the Member Engagement department.
- Responsible for meeting and exceeding monthly goals as assigned.
- Conducts outbound phone calls and/or receiving inbound phone calls within the department’s goal timeframe.
- Collaborates with our partners to facilitate the member experience.
- Participates in required team meetings and trainings.
Requirements:
- 1+ year of healthcare experience.
- 1+ year experience with Medi-Cal, Commercial, and Medicare Managed Care Plans and/or Sales, Customer Service, or Membership and Eligibility.
- Solid knowledge and understanding of the Medicare Managed Care Manual Chapter 2 - Medicare Advantage Enrollment and Disenrollment and Medicare Communications and Marketing Guidelines.
- Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors; Ability to troubleshoot/problem solve.
- High School Diploma or GED required. Bachelor's degree or four years additional experience in lieu of education preferred.
- Bilingual in one of the following Spanish, Vietnamese, Mandarin, Cantonese, or Korean preferred.
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