Remote-Resolution Specialist (Spanish Bilingual)

📋 Description

• • The Remote-Resolution Specialist (Spanish Bilingual) is a frontline problem solver responsible for managing and resolving complex member issues through proactive outreach, case ownership, and cross-functional coordination, ensuring member concerns related to authorizations, claims, benefits, provider access, and service experience are resolved accurately, compassionately, and within defined turnaround times.
• • Day to day, the specialist manages assigned member resolution cases from intake through final closure, conducts outbound outreach and handles inbound contacts to investigate and resolve issues, provides clear explanations of health plan benefits and coverage policies, maintains accurate case documentation in required systems, collaborates with internal departments and external partners to resolve complex concerns, and identifies recurring issues or trends to share insights for process improvement.
• • Alignment Healthcare, LLC is breaking the mold in conventional health care by serving seniors and the chronically ill and frail, with a mission to put the senior first; the company has built a team of passionate and caring people dedicated to transforming lives and saving them through innovation and growth in a fast-growing environment.
• • In this role, the person can learn to navigate complex healthcare systems, develop expertise in Medicare Advantage and managed care benefits, strengthen cross-functional collaboration skills, gain experience in regulatory compliance and quality service delivery, and grow into a trusted subject matter resource for escalated member issues while contributing to operational performance improvements and member satisfaction.