Member & Provider Support Specialist II

Molina Healthcare; Louisville (KY); On-site; USD 21,000 - 36,000; Full time

Job summary

Molina Healthcare is seeking a level II customer service specialist to support members and providers across multiple states via phone, chat, and email. You will resolve issues, document interactions, and contribute to quality initiatives while maintaining Molina values.

Responsibilities include handling benefits, claims, eligibility, and portal inquiries, with focus on retention, first-call resolution, and data accuracy. Strong communication and HIPAA discipline are essential.

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 skills.
• Ability to maintain confidentiality and comply with HIPAA.
• 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 multiple channels.
• Supports member/provider issues involving appeals, research and resolution, and materials.
• Assists members/providers with focus on process improvement and retention.
• Delivers excellent customer service and first call resolution.
• Documents calls across multiple platforms.
• Works scheduled shifts and adheres to lunch/break protocols; overtime/weekends as needed.
• Builds rapport empathetically and exceeds customer expectations.
• Listens attentively, captures information, and resolves inquiries.
• Meets/exceeds performance goals in call quality, attendance, and adherence.
• Engages with stakeholders and demonstrates ownership of real-time solutions.

Skills

Customer service

Data processing

Attention to detail

HIPAA compliance

Communication skills

Tools

Microsoft Office

Microsoft Teams

Genesys

Salesforce

Pega

QNXT

CRM

Verint

Video conferencing

Availity

Job description

Molina Healthcare is seeking a level II customer service specialist to support members and providers across multiple states via phone, chat, and email. You will resolve issues, document interactions, and contribute to quality initiatives while maintaining Molina values.

Responsibilities include handling benefits, claims, eligibility, and portal inquiries, with focus on retention, first-call resolution, and data accuracy. Strong communication and HIPAA discipline are essential.