Representative, Support Center II (Bilingual English/Spanish)

Molina Healthcare•Long Beach, CA

About The Position

Provides level II support center customer service 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 engagement and retention. The role serves multiple states and products across phone, chat, email, and other communication channels, as well as administrative off-phone duties supporting Medicaid, Medicare, and/or Marketplace lines of business. The representative handles a range of member and provider inquiries, including benefits, claims, premiums, provider portals, eligibility, authorizations, appeals, contracting, and credentialing. The role requires proficiency in at least two lines of business and may involve scheduled overtime and weekends 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.
Bilingual English/Spanish, as indicated in the job title.

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 communication channels including phone, chat, and email, and perform related administrative off-phone duties.
Support member and provider issues involving appeals and grievances, research and resolution, and the 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 within Molina's hours of operation, 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 goals for call quality, attendance, adherence, and other support center objectives.
Collaborate proactively with internal and external stakeholders.
Take ownership of real-time solutions and timely member and/or provider follow-up.
Research and resolve inquiries involving benefits, claims, premiums, provider portals, member eligibility, and other issues.
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.