Hybrid-Customer Experience Lead (Orange, CA)

Overview
Alignment Health is committed to serving seniors and those who need it most: the chronically ill and frail. Our mission is to put the senior first and transform the lives of the seniors we serve.

Position Summary
The hybrid Member Experience & Engagement Lead is a subject matter expert in the health care experience our members navigate daily. The role supports inbound and outbound call experience while accelerating team performance. The Lead ensures team members possess the necessary skills and training through daily performance monitoring focused on production, quality, and service metrics.

Minimum of 1 to 2 days in the office per week.

Responsibilities

Acts as the subject matter expert for procedures, protocols, benefits, services, and other necessary information to resolve member issues and inquiries.

Leads specific projects, products, regions, or other specializations as assigned, including complex or VIP member issues.

Assumes the tier two role: answers incoming member calls, conducts outbound calls, and meets productivity metrics.

Addresses complaints against the health plan and its contracted facilities per applicable grievance procedures.

Assists in defining and monitoring performance and productivity standards.

Assists with onboarding of entry‑level staff, including nesting and quality assurance of call monitoring during training.

Collaborates with the Trainer and QA Specialist to identify training needs; participates in regular meetings to report call trends and identify improvement opportunities.

Maintains confidentiality and upholds standards for privacy, data integrity, and security.

Encourages cooperation, teamwork, and accountability among department employees.

Performs other duties as assigned.

Minimum Requirements
Experience

Required: Minimum three (3) years of customer service experience.

Preferred: 5+ years customer service experience; healthcare experience; previous Lead experience.

Education

Required: High School Diploma or GED.

Preferred: College courses.

Specialized Skills

Knowledge of Medicare Managed Care Plans.

40+ words per minute and ability/experience with 10-key by touch.

Ability to communicate positively, professionally, and effectively with others; provide leadership, teach, and collaborate.

Effective written and oral communication skills; ability to establish and maintain constructive relationships with diverse members, management, employees, and vendors.

Mathematical skills: add/subtract two‑digit numbers, multiply/divide in 10’s and 100’s, perform operations using units of American money, weight, volume, and distance.

Reasoning skills: apply common sense understanding to follow detailed instructions; deal with problems involving a few concrete variables in standardized situations.

Advanced problem‑solving: prioritize multiple tasks; use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement, and manage appropriate resolution.

Problem‑solving, organizational, and time‑management skills; ability to work in a fast‑paced environment.

Preferred

Bi‑lingual (English/Spanish).

Licensure

Required: None.

Work Environment
The work environment is representative of those encountered while performing the essential functions of this job. Reasonable accommodations may be made for individuals with disabilities. The noise level is usually moderate.

Essential Physical Functions

Regularly sit; use hands to finger, handle, or feel; talk or hear.

Frequently walk; stand; reach with hands and arms.

Occasionally climb or balance and stoop, kneel, crouch, or crawl.

Occasionally lift and/or move up to 20 pounds.

Specific vision abilities: close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

Pay Range: $44,790.00 – $67,185.00. Pay may be based on location, education, responsibilities, and experience.

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.

Disclaimer
Please beware of recruitment phishing scams. Alignment Health and its subsidiaries will never ask for a credit card, send a check, or request payment as part of consideration for employment. Report incidents to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. Verify legitimacy of emails by contacting careers@ahcusa.com.

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