Fully Remote
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Customer Success Lead is a critical frontline leader and subject matter expert responsible for managing complex, urgent, and high-visibility member escalations including executive-level escalations. Reporting directly to the Supervisor, Customer Success, this role operates as a “working lead,” balancing direct member interaction with team support and operational oversight.
This role requires strong ownership, sound judgment, and a deep commitment to service recovery excellence. The Lead is accountability for resolving escalations end-to-end, especially those that are sensitive, time-critical, or impactful to senior leadership, while consistently delivering empathetic, compassionate, and human-centered experiences
In close partnership with frontline Specialists, the Lead provides real-time guidance, removes barriers, and ensures high-quality, timely resolution aligned with organizational standards, regulatory requirements, service expectations and caring connections.
Job Duties/Responsibilities:
Escalation Ownership & Service Recovery Excellence
- Take full ownership of complex, urgent, and high-visibility member escalations, including executive and market leader cases, ensuring timely and complete resolution.
- Lead service recovery efforts with a focus on empathy, active listening, and restoring member trust through meaningful and caring interactions.
- Serve as the primary point of contact for sensitive or escalated issues, demonstrating accountability from intake through resolution.
- Ensure all escalation responses are accurate, compliant, and aligned with organizational tone and quality expectations.
- Partner cross-functionally to remove barriers and drive resolution for escalations that require coordination across departments.
Operational Support Responsibilities
- Maintain a “working” role by handling inbound and outbound member interactions in alignment with departmental productivity and service level goals.
- Support daily triage and prioritization of escalation cases, ensuring appropriate assignment and timely follow-up.
- Monitor active cases to ensure adherence to SLAs, quality standards, and service recovery expectations.
- Address complaints and grievances in accordance with Medicare Managed Care requirements and internal procedures.
Frontline Team Support & Enablement
- Serve as a subject matter expert and primary resource for Specialists, providing real-time guidance, coaching, and escalation support.
- Actively support frontline Specialists in navigating complex cases, reinforcing an ownership mindset and high standards of member care.
- Foster a culture of empathy and accountability across the team.
- Assist with onboarding, including nesting support, live call monitoring, and guidance to ensure readiness and confidence.
Performance Monitoring & Continuous Improvement
- Assist in monitoring individual and team performance across productivity, quality, and service metrics.
- Identify trends in escalations and member feedback; provide insights and recommendations to leadership.
- Partner with Training and leadership to identify skill gaps and support ongoing development initiatives.
- Contribute to process improvement efforts aimed at reducing escalations, efficiencies and improving the overall member experience.
Collaboration & Communication
- Collaborate closely with the Supervisor, Customer Success to ensure alignment of priorities, escalations, and team performance.
- Maintain clear, professional, and effective communication with internal stakeholders, including leadership and cross-functional partners.
- Support reporting needs related to escalation trends, risks, and service recovery outcomes.
Compliance & Confidentiality
- Maintain strict adherence to HIPAA, privacy, and data security standards.
- Ensure all member interactions and case documentation meet regulatory and organizational compliance requirements.
Other Responsibilities
- Assist with monitoring attendance and schedule adherence.
- Encourage a culture of accountability, collaboration, and continuous improvement.
- Perform other duties as assigned.
- Supports the Supervisor, Customer Success in the day-to-day oversight of team operations. Assists with planning and monitoring work; provides input on performance, as needed. Acts as a role model and leader within the team, particularly in handling escalations and supporting frontline staff.
Job Requirements:
Experience:
- Required:
- Strong knowledge of Medicare Managed Care plans required
- 3+ years of customer service experience required (healthcare preferred)
- Previous Lead or equivalent experience required
- Preferred:
- Experience handling complex or executive-level escalations strongly preferred
- Bilingual (English/Spanish) preferred
Education:
- Required: High school diploma or GED with relevant work experience
- Preferred: Diploma, or related field with relevant work experience
Training:
- Required: None
Specialized Skills:
• Required:
- Working knowledge of Microsoft Excel, PowerPoint, SharePoint, and Power BI
- Experience with Microsoft Teams and case management systems
- Strong communication skills with the ability to bridge people, process, and technology
- Demonstrated ability to handle high-pressure situations with professionalism and sound judgment
- Strong ownership mindset and accountability
- Empathy and emotional intelligence in high-stress interactions
- Conflict resolution and de-escalation expertise
- Critical thinking and problem-solving skills
- Ability to influence and support peers without direct authority
• Preferred:
- Bilingual (English/Spanish)
Licensure:
• Required: None
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
- The employee is frequently required to walk; stand; reach with hands and arms.
- The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.
- The employee must occasionally lift and/or move up to 20 pounds.
- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact careers@ahcusa.com
Pay Range: $44,790.00 - $67,185.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
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.
