Description
JOB DESCRIPTION
Job Summary
- Provides level II support center customer service excellence to meet the needs of Molina members and providers.
- Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values.
- Provides product and service information, identifies opportunities to improve the member and provider experience, and supports continuous quality improvement initiatives related to member/provider engagement and retention.
Essential Job Duties
- Provides service support to members and/or providers using one or more support center communication channels serving multiple states and/or products including but not limited to: phone, chat and email, in addition to other administrative off phone duties supporting Medicaid, Medicare and/or Marketplace lines of business.
- Supports member/provider issues in areas involving member/provider impact and engagement including: appeals and grievances (A&G), problem research and resolution, and the development/maintenance of member/provider materials.
- Assists members and providers with a focus on process improvement and retention.
- Consistently delivers excellent customer service and first call resolution.
- Accurately documents all calls across multiple platforms.
- Works regularly scheduled shifts within Molina hours of operation, follows protocol related to scheduled lunches and breaks, and accommodates overtime and/or weekends as needed.
- Quickly builds rapport and responds to customers in an empathetic manner by identifying and exceeding customer expectations.
- Listens attentively, captures relevant information, and identifies and resolves member and provider inquiries and concerns.
- Meets or exceeds individual performance goals established in the areas of: call quality, attendance, adherence and other support center objectives.
- Proactively engages and collaborates with various internal/external stakeholders.
- Demonstrates personal responsibility and accountability by taking ownership of real-time solutioning and timely member and/or provider follow-up.
- Supports a wide variety of member and provider inquiries involving benefits, claims, premiums, provider portal, member eligibility, and other issues; conducts initial research and works to immediately resolve issues.
- Evaluates risk criteria and determines urgency and appropriate escalation path.
- Demonstrates proficiency in at least two lines of business (e.g., Medicaid, Marketplace).
- Manages multiple channels of communication (e.g., Teams, email) within a timely manner.
- Demonstrates understanding of provider service inquiries related to claims, authorizations, appeals, contracting and credentialing.
Required Qualifications
- At least 1 year of customer service, call center and/or sales experience in a fast-paced/high-volume environment, or equivalent combination of relevant education and experience.
- Customer service skills.
- Data processing experience.
- Attention to detail, organizational and time-management skills, and ability to manage simultaneous tasks to meet business needs.
- Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA).
- Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and customers.
- Effective verbal and written communication skills.
- Proficiency in Microsoft Office suite and applicable software programs.
Preferred Qualifications
- Systems training/experience for the following : Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing, CVS Caremark, Availity.
- Call center experience.
- Managed care/health care experience.
- Broker/health insurance license.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package.
Molina Healthcare is an Equal Opportunity Employer (EOE M/F/D/V)