Healthcare Call Center Representative (Level 2) - Remote

RemoteFetch; United States; Remote; USD 36,000 - 48,000; Full time

Job summary

Molina Healthcare is seeking a customer service professional to provide level II support to Molina members and providers across multiple states via phone, chat and email.

You will resolve issues, document calls, and collaborate with internal teams to improve the member and provider experience while upholding HIPAA requirements.

The role emphasizes accurate information delivery on benefits, claims, premiums and provider portal access, with a focus on first-call resolution and responsiveness.

Qualifications

• 1 year of customer service, call center, and/or sales experience in a fast-paced/high-volume environment.
• Strong customer service skills and data processing experience.
• Attention to detail, organizational and time-management skills.
• Ability to maintain confidentiality and comply with HIPAA.
• Ability to establish and maintain positive work relationships with coworkers, members and providers.
• Effective verbal and written communication skills.
• Proficiency in Microsoft Office and applicable software programs.

Responsibilities

• Provide level II support to members/providers using multiple channels (phone, chat, email) across states/products.
• Resolve member/provider issues including appeals/grievances and research/resolution.
• Assist with process improvement and retention.
• Deliver excellent customer service and first-call resolution.
• Document all calls across multiple platforms.
• Follow Molina hours, including lunches breaks and overtime as needed.
• Build rapport and respond empathetically to customers.
• Handle inquiries about benefits, claims, premiums, provider portal, eligibility, etc.; conduct initial research and resolve.
• Evaluate risk and determine escalation path.
• Demonstrate proficiency in at least two lines of business (e.g., Medicaid, Marketplace).
• Manage multiple channels (Teams, email) timely.

Skills

Customer service

Data processing

HIPAA compliance

Communication skills

Multitasking

Tools

Microsoft Office

Genesys

Salesforce

Pega

QNXT

CRM

Verint

Job description

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.

Molina Healthcare offers a competitive benefits and compensation package.

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