Remote-Bilingual Spanish Resolution Specialist

Remote Resolution Specialist (Bilingual Spanish) Alignment Health is seeking a Remote Resolution Specialist to join our member engagement team. The role focuses on resolving complex member issues related to healthcare insurance claims, authorizations, and provider network matters. The specialist will use analytical skills and in‑depth knowledge of healthcare policies to provide timely, accurate resolutions and enhance member satisfaction. Schedule Monday‑Friday Pacific Time: 8:00am – 5:00pm Mountain Time: 9:00am – 6:00pm Central Time: 10:00am – 7:00pm Eastern Time: 11:00am – 8:00pm No time off during the first five‑week training period. No time off during the entire month of January. Responsibilities Serve as a subject‑matter expert on escalated member calls, including authorizations, claims, and provider network issues. Resolve escalations based on healthcare processes and protocols. Identify and recommend process‑improvement opportunities within the member engagement department. Maintain knowledge of procedures, protocols, benefits, and services relevant to member issue resolution. Conduct outbound and inbound calls within the department’s goal time frame and manage member communication preferences. Collaborate with partners, supplemental benefit vendors, and provider networks to facilitate the member experience. Identify members with care gaps or for applicable campaigns, assess eligibility, and connect them to appropriate programs or providers. Document real‑time activity and complete timely wrap‑ups in all required systems with high data accuracy. Meet individual and team goals, submitting activity reports per required format and frequency. Provide excellent customer service and contribute to a culture of going “above and beyond” for member satisfaction. Participate in required team meetings, trainings, and demonstrate understanding of new information and processes. Adhere to attendance and productivity policies. Assist in training new hires through shadowing and nesting. Qualifications Minimum 1 year of healthcare experience and/or training; 3‑4 years of healthcare experience preferred. Minimum 1 year of outbound call‑center experience (welcome/onboarding, scheduling, retention, sales, or health‑plan‑related programs) or comparable inbound experience with escalation resolution. Experience navigating Medicare Advantage or HMO access, including referrals and authorizations. Experience with Medicare Advantage benefits: medical, prescription drug, and supplemental benefits. High school diploma, GED, or equivalent combination of education and experience. Intermediate proficiency in Microsoft Office Suite (Outlook, Word, Excel). Bilingual proficiency in English and Spanish; additional language skills (Chinese Mandarin/Cantonese or Vietnamese) are a plus. Independent, motivated self‑starter with strong prioritization skills. Strong customer‑service orientation and comfort on the phone. Excellent problem‑solving and troubleshooting abilities. Ability to read and interpret documents such as safety rules, operating instructions, and procedure manuals. Strong communication skills, including written reports and correspondence. Work Environment Remote position with availability for full‑time work throughout the Annual Enrollment Period (October‑December) and Open Enrollment Period (January‑March). Overtime may be required during these peak times. Compensation Pay Range: $41,600.00 – $57,600.00, based on market, location, education, responsibilities, and experience. Equal Opportunity 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. #J-18808-Ljbffr E2E Alignment Healthcare USA, LLC