Representative, Support Center II

Molina Healthcare•Long Beach, CA

11h

About The Position

The Representative, Support Center II provides level II customer service to Molina members and providers across multiple states and lines of business, including Medicaid, Medicare, and Marketplace. The role resolves issues, provides product and service information, supports member and provider engagement and retention, and contributes to continuous quality improvement. Support is delivered through communication channels such as phone, chat, and email, as well as administrative off-phone duties. The stated support center hours are Monday through Friday, 7 a.m. to 7 p.m. CST; employees work regularly scheduled shifts and may need to accommodate overtime or weekends.

Requirements

At least 1 year of customer service, call center, and/or sales experience in a fast-paced, high-volume environment, or an 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 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.

Nice To Haves

Systems training or experience with Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing, CVS Caremark, or Availity.
Call center experience.
Managed care or health care experience.
Broker or health insurance license.

Responsibilities

Provide support to members and providers through phone, chat, email, and other communication channels, along with administrative off-phone duties.
Support member and provider issues involving appeals and grievances, research and resolution, and development or maintenance of member and provider materials.
Assist members and providers with a focus on process improvement and retention.
Deliver excellent customer service and first-call resolution.
Accurately document calls across multiple platforms.
Follow scheduled shifts and protocols for lunches and breaks, and accommodate overtime and/or weekends as needed.
Build rapport, respond empathetically, and identify and exceed customer expectations.
Listen attentively, capture relevant information, and identify and resolve member and provider inquiries and concerns.
Meet or exceed performance goals related to call quality, attendance, adherence, and other support center objectives.
Collaborate with internal and external stakeholders.
Take ownership of real-time solutions and timely member or provider follow-up.
Address inquiries involving benefits, claims, premiums, provider portals, member eligibility, and other issues; conduct initial research and seek immediate resolution.
Evaluate risk criteria and determine urgency and the appropriate escalation path.
Demonstrate proficiency in at least two lines of business, such as Medicaid and Marketplace.
Manage multiple communication channels, such as Teams and email, in a timely manner.
Handle provider service inquiries related to claims, authorizations, appeals, contracting, and credentialing.