Healthcare Call Center Representative (Level 2) – Remote

UnitedHealth Group; United States; Remote; USD 42,000 - 60,000; Full time

Job summary

Molina Healthcare is seeking a Level II Customer Support Specialist in the United States to assist members and providers through multiple channels, resolving issues and providing product information to enhance the member/provider experience across Medicaid, Medicare, and Marketplace lines.

The role emphasizes empathy, accurate documentation, and collaboration with internal stakeholders while meeting performance goals and maintaining HIPAA compliance.

Qualifications

• At least 1 year of customer service in a fast-paced/high-volume environment.
• Customer service skills.
• Data processing experience.
• Attention to detail, organizational and time-management abilities.
• Ability to maintain HIPAA confidentiality.
• Effective verbal and written communication skills.
• Proficiency with Microsoft Office and applicable software.

Responsibilities

• Provide level II support to Molina members and providers via phone, chat and email across multiple states/products.
• Research and resolve issues, addressing member/provider impact and engagement.
• Assist with process improvement and retention efforts.
• Deliver excellent customer service and first-call resolution.
• Accurately document calls across platforms and systems.
• Work scheduled shifts within Molina hours; follow break/lunch protocols; overtime/weekends as needed.
• Build rapport empathetically and exceed customer expectations.
• Capture relevant information and resolve inquiries or escalate as appropriate.
• Meet or exceed performance goals for call quality and attendance.
• Collaborate with internal/external stakeholders effectively.
• Handle benefits, claims, eligibility, and provider portal questions; perform initial research.
• Evaluate risk and determine escalation paths; understand multiple lines of business.

Skills

Customer service

Data processing

Attention to detail

Time management

HIPAA

Verbal and written communication

Microsoft Office

Tools

Microsoft Office suite

CRM software

Genesys

Salesforce

Pega

QNXT

Verint

Job description

JOB DESCRIPTION Job Summary

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 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.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V