Health Plan Member Support Specialist

Molina Healthcare; Montana; On-site; USD 19,000 - 28,000; Full time

Job summary

Molina Healthcare is seeking a customer service professional to provide level I support to members and providers across multiple channels, addressing inquiries and resolving issues within Medicaid, Medicare, and Marketplace lines of business.

The role emphasizes empathy, accuracy in documentation, and collaboration with internal and external stakeholders, with a focus on meeting performance goals and maintaining confidentiality per HIPAA guidelines.

Qualifications

• Up to 1 year of customer service, call center and/or sales experience in a fast-paced/high-volume environment, or 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 the Health Insurance Portability and Accountability Act (HIPAA).
• Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and customers.
• Effective verbal and written communication skills.
• Basic proficiency in Microsoft Office suite and applicable software programs.

Responsibilities

• Provides service support to members and/or providers using one or more support center communication channels serving multiple states and/or products including but not limited to: phone, chat and email, in addition to other administrative off phone duties supporting Medicaid, Medicare and/or Marketplace lines of business.
• Conducts various surveys related to health assessments and member/provider satisfaction.
• Accurately documents pertinent details related to member or provider inquiries.
• Works regularly scheduled shifts within Molina hours of operation, follows protocol related to scheduled lunches and breaks, and accommodates overtime and/or weekends as needed.
• Demonstrates ability to quickly build rapport and respond to customers in an empathetic manner by identifying and exceeding customer expectations.
• Listens attentively, captures relevant information, and identifies member or provider inquiries and concerns.
• Meets or exceeds individual performance goals established for the position in the areas of: call quality, attendance, adherence and other support center objectives.
• Proactively engages and collaborates with various internal/external stakeholders.
• Demonstrates personal responsibility and accountability by taking ownership of real-time solutioning and timely member and/or provider follow‑up.
• Supports provider needs related to inquiries and assistance involving member eligibility and covered benefits, provider portal, and status of submitted claims.

Skills

Customer service

Data processing

HIPAA

Microsoft Office

Communication skills

Attention to detail

Time management

Organizational skills

Tools

Microsoft Office

Job description

Molina Healthcare is seeking a customer service professional to provide level I support to members and providers across multiple channels, addressing inquiries and resolving issues within Medicaid, Medicare, and Marketplace lines of business.

The role emphasizes empathy, accuracy in documentation, and collaboration with internal and external stakeholders, with a focus on meeting performance goals and maintaining confidentiality per HIPAA guidelines.