Remote Customer Service Representative (Bilingual in Spanish)

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast‑growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them.

The Remote Regional Concierge Navigator provides outreach and support to all our members, ensuring they have access to the care they deserve. The role supports our members in navigating through their health care and benefits, connecting the dots between our provider network, health plan operations, and supplemental vendors. The Navigator maintains a high knowledge of the member needs of their respective market and assists members every step of the way to ensure they are never alone in their healthcare journey and have the highest level of coordinated care. The Navigator lays the groundwork for future and ongoing member support and has familiarity with assigned markets to contribute meaningfully to members’ healthcare outcomes.

Responsibilities

• 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 resolves quality member issues for all assigned cases.
• Ensures members have access to PCPs 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 life cycle of the program by addressing program‑specific quality measures and adhering to company guidelines and standard operating procedures.
• Schedules patient appointments, sends reminders, and confirms appointments and mails letters and correspondence as needed.
• Places regular and consistent outreach to the patient.
• Communicates with PCPs regarding member updates and requests.
• Assists with obtaining medical records from any healthcare providers involved in care or hospitals.
• Helps members with 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 a member’s primary care physician and engages members proactively with their wellness plan options.
• Participates in on‑site member engagement activities as needed, such as in‑person member meetings and handling lobby calls at a retail or care center location (subject to change).
• Performs other duties as assigned.

Experience

Required: Minimum 1 year of customer service experience.

Preferred: High‑volume inbound customer service experience, particularly for health plan or Medicare “Member Services” roles; telemarketing and/or member outreach experience; specialized experience in escalation or resolution units.

Education

Required: High School Diploma or GED.

Specialized Skills

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.
• Professional, positive, and effective communication with others; ability to provide leadership, teach, and collaborate with peers.
• 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 such as safety rules, operating and maintenance instructions, and procedure manuals; ability to write routine reports and correspondence; ability to speak effectively before groups of customers or employees.
• Reasoning skills: ability to apply common sense to carry out detailed but routine written or oral instructions; ability to handle problems involving a few concrete variables in standardized situations.
• Mathematical skills: ability to perform mathematical calculations and calculate simple statistics correctly.
• Problem‑solving, organizational, and time‑management skills; ability to work in a fast‑paced environment.

Preferred:

• Bilingual English/Spanish or English/Vietnamese or English/Mandarin. Fluency in written and verbal Spanish, Korean, or Vietnamese is a plus.

Licensure

None.

Work Environment

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

1. While performing the duties of this job, the employee is regularly required to talk or hear, stand, walk, sit, use hands and fingers to handle objects, tools, or controls, and reach with hands and arms.

2. The employee frequently lifts and/or moves objects weighing up to 10 pounds. Specific vision abilities required include close vision and the ability to adjust focus.

Pay Range

$44,790.00 - $67,185.00

Equal Opportunity Employer

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.