Director, Member & Provider Experience & Support

Molina Healthcare; Northern (KY); Hybrid; USD 88,000 - 190,000; Full time

Job summary

Molina Healthcare is seeking an experienced leader to direct the member and provider support center, aligning service delivery with regulatory requirements and Molina values. You will oversee teams delivering exceptional customer service across benefits, claims, and billing inquiries, while driving retention through proactive outreach and quality improvements.

Responsibilities include mentoring managers, meeting KPIs, leading audits (NCQA/HEDIS as applicable), and collaborating across business

Qualifications

• 8+ years of customer service experience in a fast-paced/high-volume environment, including 7+ years in a call center.
• At least 3 years of management/leadership experience.
• Strong customer service skills.
• Understanding of Medicaid, Medicare and Marketplace enrollment processes.
• Organizational and time-management skills; ability to manage multiple projects to deadlines.
• Ability to maintain confidentiality and comply with HIPAA.
• Ability to work cross-functionally across a matrixed organization.
• Excellent verbal and written communication skills.
• Proficiency with Microsoft Office suite and related software.

Responsibilities

• Provides leadership and oversight for the member and provider support center; ensures exemplary service is delivered according to Molina goals/objectives/policies/procedures and regulatory requirements, and demonstrates accountability for performance and financial outcomes.
• Directly leads support center leadership that oversees teams that support servicing of members and providers.
• Delivers effective customer service for all service needs including benefits, claims, billing inquiries, service requests, suggestions and complaints.
• Resolves member and provider inquiries and complaints fairly and effectively.
• Provides direction and coordination to deliver accurate product and service information to members and providers, and identifies opportunities to increase membership by improving the member and provider experience.
• Recommends and implements programs to support member and provider needs.
• Works collaboratively within a matrix environment with dotted line relationships across multiple lines of business.
• Works cross collaboratively with other teams and departments.
• Meets and exceeds department KPIs including productivity and service quality goals; implements strategies to meet/exceed goals.
• Drives process improvements to ensure performance goals including quality goals are met.
• Participates in audits including state, federal, NCQA and HEDIS as applicable.
• Provides exemplary customer service to all customers including members, co-workers, vendors, providers, government agencies, business partners and the general public.
• Sets a positive example for others and builds the Molina culture by modeling the Molina mission, vision and values in daily actions.
• Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of department-specific goals.
• Models dynamic leadership for support center leadership team and representatives; develops team to focus on delivering great health care/customer service to underserved populations.

Skills

Customer service

Call center experience

Leadership

HIPAA compliance

Time management

Multitasking

Verbal and written communication

Microsoft Office

Cross-functional collaboration

Tools

Genesys

Salesforce

Pega

QNXT

Verint

CRM

Job description

Molina Healthcare is seeking an experienced leader to direct the member and provider support center, aligning service delivery with regulatory requirements and Molina values. You will oversee teams delivering exceptional customer service across benefits, claims, and billing inquiries, while driving retention through proactive outreach and quality improvements.

Responsibilities include mentoring managers, meeting KPIs, leading audits (NCQA/HEDIS as applicable), and collaborating across business