Member & Provider Support Specialist II

Molina Healthcare; Toledo (OH); On-site; USD 32,000 - 55,000; Full time

Benefits offered by this job

Competitive benefits package

Job summary

Molina Healthcare in Toledo, OH is seeking a customer service professional to provide level II support to members and providers across Medicaid, Medicare and Marketplace lines. The role emphasizes efficient issue resolution and member/provider engagement within Molina values.

Responsibilities include handling calls, chats, and emails; documenting interactions; collaborating with internal teams; and maintaining compliance with HIPAA while aiming for high customer satisfaction.

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

• Provide level II support to members and/or providers via multiple channels (phone, chat, email) across states/products.
• Support member/provider issues including appeals, grievances, and materials development/maintenance.
• Assist members/providers with process improvement and retention.
• Deliver excellent customer service and strive for first call resolution.
• Document all calls across multiple platforms accurately.
• Work shifts within Molina hours; adhere to breaks and overtime as needed.
• Build rapport empathetically and exceed customer expectations.
• Escalate and collaborate with stakeholders as needed.
• Handle inquiries related to benefits, claims, premiums, provider portal, and eligibility; perform initial research to resolve issues.

Skills

Customer service

Data processing

Attention to detail

Time management

HIPAA compliance

Communication skills

Microsoft Office

Tools

Genesys

Salesforce

Pega

QNXT

CRM

Verint

Availity

Job description

Molina Healthcare in Toledo, OH is seeking a customer service professional to provide level II support to members and providers across Medicaid, Medicare and Marketplace lines. The role emphasizes efficient issue resolution and member/provider engagement within Molina values.

Responsibilities include handling calls, chats, and emails; documenting interactions; collaborating with internal teams; and maintaining compliance with HIPAA while aiming for high customer satisfaction.