Member & Provider Care Specialist II

Molina Talent Acquisition; United States; Remote; USD 36,000 - 52,000; Full time

Job summary

Molina Healthcare is seeking a Customer Service professional for its rapidly evolving member and provider support center. You will handle inquiries across Medicaid, Medicare, and Marketplace lines, using phone, chat, and email to resolve issues and document interactions.

The role requires strong communication, data processing skills, and adherence to HIPAA. You will collaborate with stakeholders, aim for first-call resolution, and support quality improvement initiatives within a patient-first

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.

Responsibilities

• Provides service support to members and/or providers using channels like phone, chat and email across multiple states and products including Medicaid, Medicare and Marketplace.
• Supports member/provider issues including appeals and grievances, problem research and resolution, and maintenance of member/provider materials.
• Assists members/providers with a focus on process improvement and retention.
• Delivers excellent customer service and first call resolution.
• Documents all calls across multiple platforms.
• Works shifts within Molina hours of operation, follows lunch/break protocol, and may accommodate overtime/weekends.
• Builds rapport empathetically and responds to customers while meeting or exceeding expectations.
• Listens, captures relevant information, and resolves inquiries and concerns.
• Meets/exceeds performance goals in call quality, attendance, and adherence.
• Engages with internal/external stakeholders.
• Takes ownership of real-time solutioning and follow-up.
• Supports inquiries on benefits, claims, premiums, provider portal, eligibility, and more; conducts initial research and resolves issues.
• Evaluates risk criteria and escalation path.
• Demonstrates proficiency in at least two lines of business (e.g., Medicaid, Marketplace).
• Manages multiple channels (Teams, email) in a timely manner.
• Understands provider service inquiries related to claims, authorizations, appeals, contracting and credentialing.

Skills

Customer service

Data processing

Attention to detail

HIPAA compliance

Verbal and written communication

Microsoft Office

Tools

Microsoft Office

Microsoft Teams

Genesys

Salesforce

Pega

QNXT

CRM

Verint

Video conferencing

CVS Caremark

Availity

Job description

Molina Healthcare is seeking a Customer Service professional for its rapidly evolving member and provider support center. You will handle inquiries across Medicaid, Medicare, and Marketplace lines, using phone, chat, and email to resolve issues and document interactions.

The role requires strong communication, data processing skills, and adherence to HIPAA. You will collaborate with stakeholders, aim for first-call resolution, and support quality improvement initiatives within a patient-first