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

Molina Healthcare•Long Beach, OH

4d•Remote

About The Position

Molina of Ohio is hiring a Senior Specialist, Member Engagement to analyze and review member Value Added Benefits and support continuous quality improvement in member engagement and retention. The role represents the member perspective in matters affecting member impact and engagement, and oversees, tracks, and reports on value-added benefits for Medicaid and MyCare Ohio. It is remote, but applicants must reside in Ohio. The position provides senior-level support for member engagement, advocacy, and retention. It involves helping members understand their rights, plan benefits, covered and preventive services, and complaint and appeal processes. The specialist handles complex member concerns, investigates access and cultural-sensitivity issues, coordinates with internal and external partners, identifies trends, and helps develop solutions. The role also includes documenting cases, preparing written analyses and responses, supporting training and educational materials, participating in quality improvement, and conducting focus groups or in-person meetings as appropriate.

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 working with underserved populations, preferably in a Medicaid environment; equivalent combinations of relevant education and experience are accepted.
Effective interpersonal skills and a customer-first mindset.
Experience conducting intake, interviews, 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 or applicable software programs.
Strong Excel skills, including organizing, analyzing, and interpreting complex data.
Experience reviewing dashboards, evaluating performance metrics, and combining quantitative data with qualitative feedback.
Ability to interpret complex datasets, identify trends, patterns, and gaps, and translate findings into actionable insights.
Critical thinking, problem-solving, and strategic analysis skills.
Ability to work with ambiguity, adapt as priorities and information change, and work independently with limited direction.
Initiative, ownership, follow-through, and proactive problem-solving.

Nice To Haves

Managed care experience.
Call center experience.
Smartsheet experience.

Responsibilities

Provide senior-level support for member engagement and member retention activities.
Represent members in matters involving member impact and engagement, including appeals, grievances, and research and resolution of member issues.
Provide service regarding billing inquiries, service requests, suggestions, and complaints; resolve inquiries and complaints fairly and effectively.
Provide product and service information and identify opportunities to maintain and increase member relationships.
Recommend and implement programs that support member needs and develop or maintain member materials.
Provide direct telephone assistance to members or their family members to resolve complex issues or complaints and support member engagement and retention.
Uphold enrollees’ rights and help them understand their rights and benefits while navigating the system.
Assist members with internal and state-level complaints and appeals by determining their needs, explaining their rights, making referrals for investigation and resolution, and monitoring outcomes.
Advocate for members in collaboration with providers, regulatory agencies, outside agencies, colleagues, and other departments.
Educate members about covered services, including preventive services, and support enrollees and providers in accessing plan benefits.
Provide information, guidance, and assistance by phone or in person to members with disabilities who need help related to plan participation.
Analyze internal system functions affecting enrollee access to medical care and quality of care.
Investigate and resolve access and cultural-sensitivity issues raised by enrollees, care management staff, the state, providers, advocacy organizations, and subcontractors.
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; assist with documentation for appeals, fair hearings, and other dispute-resolution processes.
Collaborate with care management to resolve member issues and concerns, identify trends, and outline solutions.
Conduct focus groups in the service delivery area as needed to ensure member needs are addressed.
Support ongoing member advocacy training and distribute advocacy educational materials to internal staff, providers, and subcontractors.
Serve as a resource for Molina staff and members regarding community agencies, services, referrals for special needs, Medicaid benefits, and related needs.
Participate in the statewide advocacy program and collaborate with the state external advocate, enrollment specialists, and ombudsmen on access, quality of care, enrollment, and disenrollment issues.
Conduct in-person meetings with members or 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 on time in the appropriate database.
Provide training and support to new and existing member engagement and retention team members.
Review and analyze member benefit and engagement data, identify trends and gaps, and communicate actionable insights to support business decisions.