Representative, Support Center II - Remote

Molina Healthcare•AZ, AZ

18h•$18 - $26•Remote

About The Position

Provides level II support center customer service to Molina members and providers across multiple states and product lines. Resolves issues and addresses needs fairly and effectively while demonstrating Molina values. Provides product and service information, identifies opportunities to improve member and provider experience, and supports continuous quality improvement related to member/provider engagement and retention. The role supports members and providers through communication channels such as phone, chat, and email, as well as administrative off-phone duties for Medicaid, Medicare, and/or Marketplace lines of business. It handles inquiries involving benefits, claims, premiums, provider portals, eligibility, authorizations, appeals, contracting, credentialing, and other issues; performs initial research and resolution, documents interactions across multiple platforms, evaluates risk, and escalates as appropriate. The representative is expected to provide empathetic, effective service, achieve first-call resolution, collaborate with stakeholders, and meet performance goals for quality, attendance, and adherence. The stated schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m., with hours depending on the employee’s time zone. The role may require overtime and/or weekend work as needed.

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/or providers through phone, chat, email, and other communication channels, along with administrative off-phone duties.
Support member and provider issues involving appeals and grievances, problem research and resolution, and development or maintenance of member/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.
Work scheduled shifts, follow scheduled lunch and break protocols, 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 individual performance goals for call quality, attendance, adherence, and other support center objectives.
Engage and collaborate proactively with internal and external stakeholders.
Take ownership of real-time solutions and timely member and/or provider follow-up.
Support inquiries involving benefits, claims, premiums, provider portals, member eligibility, and other issues; conduct initial research and work to resolve issues promptly.
Evaluate risk criteria and determine urgency and appropriate escalation paths.
Demonstrate proficiency in at least two lines of business, such as Medicaid or Marketplace.
Manage multiple communication channels, such as Teams and email, in a timely manner.
Address provider service inquiries related to claims, authorizations, appeals, contracting, and credentialing.