Representative, Support Center II - Remote

Molina Healthcare•Long Beach, CA

16h•Remote

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 provides assistance across multiple communication channels and lines of business, including Medicaid, Medicare, and Marketplace. It handles member and provider inquiries involving benefits, claims, premiums, eligibility, provider portals, authorizations, appeals, contracting, and credentialing, and conducts initial research to resolve issues or determine an appropriate escalation. The representative documents interactions, coordinates follow-up, and manages multiple communications while meeting support center performance goals.

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 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 provider service through channels such as phone, chat, and email, along with administrative off-phone duties across multiple states and lines of business.
Support member and provider issues involving appeals and grievances, problem research and resolution, and the 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 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 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.
Handle provider service inquiries related to claims, authorizations, appeals, contracting, and credentialing.