Quality Retention Specialist, Chinese – Mandarin Speaker

Alignment Health

. Serve as a subject matter expert for escalated member calls involving disenrollment risk .

Posted 9/22/2026full-timeRemote • United StatesJunior💰 $41,472 - $62,208 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare processes, particularly in Medicare Managed Care, with strong communication and problem-solving skills. Capable of managing member interactions effectively while ensuring compliance with federal and state regulations.

Highest-signal resume keywords

Healthcare ExperienceMedicare Managed Care KnowledgeEffective Communication SkillsOrganizational SkillsBilingual Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medicare Advantage EnrollmentClaims ProcessingAuthorization ManagementData EntryProcess Improvement

Soft Skills

Problem-SolvingTime ManagementAdaptabilityTeam CollaborationCustomer Service

Tools & Technologies

Member Management SystemsCommunication PlatformsReporting Tools

Certifications & Qualifications

Sales LicenseAlignment Health Plan Sales Certification

Industry Keywords

Medi-CalCommercial PlansMedicareHealth Plan ComplianceMember Engagement

About the role

Key responsibilities & impact

Serve as a subject matter expert for escalated member calls involving disenrollment risk
Resolve escalations using knowledge of healthcare, authorizations, claims, provider network issues, processes, and protocols
Identify process improvement opportunities within the Member Engagement department
Meet and exceed assigned monthly goals
Provide expert information about procedures, protocols, benefits, and services
Conduct outbound and receive inbound calls within department goal timeframes
Adapt communications to members' preferences, including time of day, channel, and language; use interpreter services as needed
Collaborate with other departments, supplemental benefit vendors, and provider networks to facilitate the member experience
Share best practices and participate in team meetings and training
Provide outbound support for PCP/IPA terminations
Ensure information and assistance comply with applicable federal/state laws, regulations, and health plan requirements
Document interactions in real time and complete timely wrap-up in required systems/applications
Accurately enter member demographics and information to support outcomes reporting and organizational data quality
Participate in required meetings and training concerning company processes, health plan benefit packages, and CMS
Assist with development and training of new hires, including shadowing
Support other assigned projects and duties

Requirements

What you’ll need

1+ year of healthcare experience
1+ year experience with Medi-Cal, Commercial, and Medicare Managed Care Plans and/or Sales, Customer Service, or Membership and Eligibility
High School Diploma or GED required
Bachelor's degree or four years additional experience in lieu of education
Solid knowledge and understanding of the Medicare Managed Care Manual Chapter 2 - Medicare Advantage Enrollment and Disenrollment and Medicare Communications and Marketing Guidelines
Effective written and oral communication skills
Ability to troubleshoot and problem-solve
Organizational and time management skills; ability to work in a fast-paced environment
Ability to read and interpret safety rules, operating and maintenance instructions, and procedure manuals
Ability to write routine reports and correspondence and speak effectively before groups
Basic mathematical skills involving two-digit numbers, American money, and measurements
Ability to apply common sense to detailed written or oral instructions and handle standardized problems
Ability to regularly talk, hear, stand, walk, sit, use hands and fingers, handle or feel objects, reach with hands and arms
Ability to frequently lift and/or move up to 10 pounds
Preferred experience helping members navigate access to care through Medicare Advantage or HMO, including referrals, authorizations, prescription drugs, and supplemental benefits
Bilingual in Spanish, Vietnamese, Mandarin, Cantonese, or Korean preferred
Sales License or completion of Alignment Health Plan sales certification preferred

Benefits

Comp & perks

Fully remote work arrangement
Opportunity for growth and innovation
Equal Opportunity/Affirmative Action employment