Quality Retention Specialist, Chinese – Mandarin Speaker

This is a fully remote position, open to applicants in United States.

📋 Description

• Act as a subject matter expert for escalated member inquiries related to disenrollment risk.

• Address escalations utilizing expertise in healthcare, authorizations, claims, provider network matters, processes, and protocols.

• Recognize opportunities for process enhancement within the Member Engagement department.

• Achieve and surpass designated monthly targets.

• Supply expert knowledge regarding procedures, protocols, benefits, and services.

• Make outbound calls and receive inbound calls within departmental time goals.

• Tailor communications to align with members' preferences including timing, channel, and language; utilize interpreter services as necessary.

• Work in collaboration with other departments, supplemental benefit vendors, and provider networks to enhance the member experience.

• Share best practices and engage in team meetings and training sessions.

• Provide outbound assistance for PCP/IPA terminations.

• Ensure information and support adhere to relevant federal/state laws, regulations, and health plan requirements.

• Document interactions in real time and complete timely follow-ups in required systems/applications.

• Accurately input member demographics and information to aid in outcomes reporting and maintain organizational data quality.

• Participate in mandatory meetings and training related to company processes, health plan benefits, and CMS.

• Assist with the training and development of new hires, including shadowing activities.

• Support other assigned projects and responsibilities.

⛳️ Requirements

• Minimum of 1 year of healthcare experience.

• At least 1 year of experience with Medi-Cal, Commercial, and Medicare Managed Care Plans, and/or in Sales, Customer Service, or Membership and Eligibility.

• High School Diploma or GED is required.

• A Bachelor's degree or four additional years of experience can be considered in place of formal education.

• Strong understanding of the Medicare Managed Care Manual Chapter 2 - Medicare Advantage Enrollment and Disenrollment, as well as Medicare Communications and Marketing Guidelines.

• Proficient written and verbal communication skills.

• Strong troubleshooting and problem-solving abilities.

• Excellent organizational and time management skills; capability to thrive in a fast-paced setting.

• Competence in reading and interpreting safety rules, operating and maintenance instructions, and procedural manuals.

• Ability to produce routine reports and correspondence and effectively present before groups.

• Basic math skills involving two-digit numbers, U.S. currency, and measurements.

• Capacity to apply common sense to detailed written or verbal instructions and address standardized issues.

• Physical ability to regularly talk, hear, stand, walk, sit, use hands and fingers, handle or feel objects, and reach with hands and arms.

• Ability to frequently lift and/or move up to 10 pounds.

• Preferred experience in assisting members with access to care via Medicare Advantage or HMO, including referrals, authorizations, prescription drugs, and supplemental benefits.

• Bilingual proficiency in Spanish, Vietnamese, Mandarin, Cantonese, or Korean is preferred.

• Sales License or completion of Alignment Health Plan sales certification is preferred.

🏝️ Benefits

• Fully remote work arrangement.

• Opportunities for growth and innovation.

• Equal Opportunity/Affirmative Action employment.