JOB DESCRIPTION Job Summary
Provides level III 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.
• Provides product and service information and identifies opportunities to
maintain and increase member/provider relationships and engagement.
• Provides excellent customer service for all support center communication
channels.
• Handles escalated calls on behalf of leadership.
• Accurately documents all member/provider communications.
• 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 a compassionate manner by
identifying and exceeding customer expectations.
• Listens skillfully, collects relevant information, determines immediate
requests and identifies the customer’s needs.
• Achieves individual performance goals established in the areas of call
quality, attendance, scheduled adherence and call center objectives.
• Demonstrates personal responsibility and accountability by taking ownership of
the customer's call/issue and following through to resolution in real-time or
via expeditious follow-up.
• Supports a wide variety of member and provider inquiries involving
eligibility, benefits, claims, premiums, authorizations, appeals, contracting,
credentialing, and other issues; conducts initial research and works to
immediately resolve issues; appropriately escalates issues based on established
risk criteria.
• Responds to incoming calls from providers on a variety of issues of varying
complexity, including highly complex or executive issues, and demonstrates
understanding of provider service inquiries related to claims, authorizations,
appeals, contracting and credentialing.
• Gathers information to critically evaluate options, seeking alternative
perspectives to identify root causes and develop solutions.
• Proficient in three or more lines of business (Medicare, Medicaid,
Marketplace, Medicare-Medicaid Plan (MMP)) - supporting member services,
provider services and member retention.
• Completes research for state, legislative or regulatory inquiries as
applicable.
• Conducts member satisfaction assessment services and other member surveys as
applicable and based on business needs.
• Assists other retention or inbound functions as dictated by service level
requirements.
• Remains professional and courteous in verbal and written communications -
utilizing concise and effective language at all times.
• Professionally engages and collaborates with other departments as needed.
• Provides training and support to new and existing support center
representatives.
Required Qualifications
• At least 2 years of customer service, call center and/or sales experience in a
fast-paced/high-volume environment, or equivalent combination of relevant
education and experience.
• Understanding of insurance products including Medicaid, Medicare and
Marketplace/enrollment processes.
• Customer service skills, including ability to conduct thorough research while
maintaining coherent conversation with customers.
• 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