Sr Specialist, Member Engagement (Member Benefits Analysis) Ohio Remote

Molina Healthcare•Long Beach, CA

4d•Remote

About The Position

Molina of Ohio is hiring a Senior Specialist, Member Engagement, to analyze and review member Value Added Benefits. The position is remote, and applicants must reside in Ohio. It supports continuous quality improvement in member engagement and retention, represents the member perspective on matters affecting member impact and engagement, and oversees, tracks, and reports on value-added benefits for Medicaid and MyCare Ohio. The role provides senior-level support for member engagement and retention, including member advocacy, complex issue resolution, and assistance with benefits, complaints, and appeals. It works with members, families, providers, state and community agencies, internal teams, and other stakeholders to address access and quality-of-care issues, uphold enrollee rights, identify trends, and develop solutions. The specialist also supports member materials and training, documents member contacts, and participates in quality assurance and improvement activities.

Requirements

At least 3 years of experience in member services, member outreach, community engagement, consumer advocacy, or customer service in a managed care or health care setting, and at least 1 year of experience working with underserved populations, preferably in a Medicaid environment; or an equivalent combination of relevant education and experience.
Effective interpersonal skills and a customer-first mindset.
Experience conducting intake, interviews, and/or research into consumer or provider issues.
Understanding of managed health care systems and behavioral health issues.
Ability to work independently and as part of a team in a fast-paced environment.
Ability to assess needs and make thoughtful decisions to support members.
Time-management and organizational skills.
Ability to work cross-functionally within a highly matrixed organization.
Effective verbal and written communication skills and professional telephone etiquette.
Proficiency with Microsoft Office and applicable software programs.
Advanced Excel proficiency to organize, analyze, and interpret complex data.
Experience reviewing dashboards and performance metrics and combining quantitative data with qualitative feedback to identify opportunities, root causes, and solutions.
Ability to analyze complex datasets, identify trends, patterns, and gaps, and translate findings into actionable insights and clear explanations.
Ability to think critically and strategically, ask questions, challenge assumptions, and develop creative solutions.
Ability to navigate ambiguity, work independently with limited direction, adapt to changing priorities, take initiative, and follow through on commitments.
Strong communication and collaboration skills, including confidence in engaging stakeholders and seeking clarification.

Nice To Haves

Smartsheet experience.
Managed care experience.
Call center experience.

Responsibilities

Support member engagement and retention activities and represent members in matters involving member impact and engagement.
Oversee, track, and report on value-added benefits for Medicaid and MyCare Ohio.
Provide service and resolve inquiries and complaints related to billing, service requests, suggestions, and other member needs.
Provide direct phone assistance to members and family members seeking resolution of complex issues or complaints.
Uphold enrollee rights and help members understand their rights and benefits.
Assist members with internal and state-level complaints and appeals, determine their needs, explain their rights, refer issues for investigation and resolution, and monitor outcomes.
Advocate for members in collaboration with providers, regulatory and outside agencies, colleagues, and other departments.
Educate members on covered services, including preventive services, and support enrollees and providers in accessing plan benefits.
Provide guidance and assistance to members with disabilities regarding plan participation and analyze internal system functions affecting access to and quality of care.
Investigate and resolve access and cultural sensitivity issues identified by members and other stakeholders.
Monitor formal and informal grievances with the appeals and grievances team and identify trends or problem areas in member access and care delivery.
Prepare timely written responses to member inquiries and written analyses of advocacy issues, and assist with documentation for appeals, fair hearings, and other dispute-resolution processes.
Collaborate with care management to resolve member issues, identify trends, and outline solutions.
Conduct focus groups in the service delivery area as needed to assess whether member needs are being addressed.
Support member advocacy training and distribute educational materials to internal staff, providers, and subcontractors.
Serve as a resource on community agencies, services, referrals for special needs, Medicaid benefits, and related needs.
Participate in the statewide advocacy program and collaborate with state external advocates, enrollment specialists, and ombudsmen on access to care, quality of care, enrollment, and disenrollment issues.
Conduct in-person meetings with members and family members as appropriate.
Participate in internal quality assurance and improvement committees to help ensure services meet state and plan requirements.
Document member contacts and cases accurately and promptly in the appropriate database.
Provide training and support to new and existing member engagement and retention team members.
Analyze and review member Value Added Benefits and use data and feedback to identify trends, gaps, and improvement opportunities.