Representative, Support Center II (Remote)

Molina Healthcare•AZ, AZ

14h•$18 - $26•Remote

About The Position

Provides level II support center customer service to meet the needs of Molina members and providers. Resolves issues 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 engagement and retention. The role provides support across multiple communication channels and lines of business, including Medicaid, Medicare, and Marketplace. It addresses member and provider inquiries about benefits, claims, premiums, eligibility, provider portals, authorizations, appeals, contracting, credentialing, and other issues. The representative conducts initial research, resolves issues when possible, assesses risk and urgency, and follows appropriate escalation paths. The position also requires accurate documentation, timely follow-up, collaboration with stakeholders, and meeting established performance goals. The role is remote and works regularly scheduled shifts within Molina’s hours of operation. Overtime and/or weekend work may be needed. Molina Healthcare offers a competitive benefits and compensation package.

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 member and/or provider support through channels such as phone, chat, and email, as well as off-phone administrative duties, across multiple states and lines of business.
Support member and provider issues involving appeals and grievances, problem 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.
Work scheduled shifts within Molina’s hours of operation, follow scheduled lunch and break protocols, and accommodate overtime and/or weekends as needed.
Build rapport and respond empathetically by identifying and exceeding 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.
Address inquiries about 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.
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.