Healthcare Call Center Representative (Level 2) – Remote

Molina Healthcare; Columbus (OH); Remote; USD 35,000 - 54,000; Full time

Job summary

Molina Healthcare in Columbus, Ohio is seeking an Ohio-resident Level II support agent to deliver customer service excellence to Molina members and providers across Medicaid, Medicare and Marketplace programs. You will handle calls, chats and emails, document interactions, resolve issues, and collaborate with internal teams to improve member and provider engagement while upholding HIPAA requirements.

This role emphasizes quality, first call resolution and proactive problem solving within

Qualifications

• 1 year or more of customer service, call center and/or sales experience in a fast-paced/high-volume environment.
• Excellent customer service skills and ability to manage multiple tasks.
• Data processing experience.
• Attention to detail, organizational and time-management skills.
• Ability to maintain confidentiality and comply with HIPAA.
• Strong verbal and written communication skills.
• Proficiency with Microsoft Office and applicable software programs.

Responsibilities

• Provide level II support center service across channels (phone, chat, email) for Medicaid, Medicare and Marketplace lines.
• Assist members and providers with appeals, grievances, and problem resolution.
• Document all calls across multiple platforms.
• Aim for first call resolution and quality in every interaction.
• Collaborate with internal/external stakeholders to improve processes.
• Work scheduled Molina hours and accommodate overtime/weekends as needed.
• Demonstrate empathy, build rapport, and capture relevant information for issue resolution.

Skills

Customer service

Communication skills

Data processing

Attention to detail

HIPAA compliance

Tools

Microsoft Office

Job description

JOB DESCRIPTION

Job SummaryMust reside in Ohio.Provides level II support center customer service excellence 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 member/provider engagement and retention.

Essential Job Duties

• 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 businessincluding 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
• Supports member/provider issues in areas involving member/provider impact and engagement including: appeals and grievances (A&G), problem research and resolution, and the development/maintenance of member/provider materials
• Assists members and providers with a focus on process improvement and retention
• Consistently delivers excellent customer service and first call resolution
• Accurately documents all calls across multiple platforms
• 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
• Quickly builds rapport and responds to customers in an empathetic manner by identifying and exceeding customer expectations
• Listens attentively, captures relevant information, and identifies and resolves member and provider inquiries and concerns
• Meets or exceeds individual performance goals established 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 a wide variety of member and provider inquiries involving benefits, claims, premiums, provider portal, member eligibility, and other issues; conducts initial research and works to immediately resolve issues
• Evaluates risk criteria and determines urgency and appropriate escalation path
• Demonstrates proficiency in at least two lines of business (e.g., Medicaid, Marketplace).
• Manages multiple channels of communication (e.g., Teams, email) within a timely manner
• Demonstrates understanding of provider service inquiries related to claims, authorizations, appeals, contracting and credentialing.

Required Qualifications

• At least 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.
• Proficiency in Microsoft Office suite and applicable software programs.

Preferred Qualifications

• Systems training/experience for the following : Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing, CVS Caremark, Availity.
• Call center experience.
• Managed care/health care experience.
• Broker/health insurance license.

Benefits

Molina Healthcare offers a competitive benefits and compensation package.

Equal Opportunity Employer

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V#PJCorp3#LI-AC1