Member & Provider Support Specialist II

Molina Healthcare; United States; On-site; USD 34,000 - 58,000; Full time

Job summary

Molina Healthcare is seeking a customer service specialist to support members and providers across Medicaid, Medicare and Marketplace lines. You will handle inquiries via phone, chat, and email, resolve issues, and document interactions with accuracy.

The role emphasizes first call resolution, empathy-driven communication, and collaboration with internal and external stakeholders in a fast-paced, high-volume environment.

Qualifications

• At least 1 year of customer service or call center experience 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.
• Ability to establish and maintain positive 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 multiple channels (phone, chat, email) across Medicaid, Medicare and Marketplace lines.
• Supports member/provider issues in areas involving member/provider impact and engagement including appeals and grievances, problem research and resolution, and materials.
• Assists members and providers with a focus on process improvement and retention.
• Delivers excellent customer service and first call resolution.
• Documents all calls across multiple platforms.
• Works scheduled shifts within Molina hours of operation and accommodates overtime/weekends as needed.
• Builds rapport and responds empathetically to customers while identifying and exceeding expectations.
• Listens attentively, captures relevant information, and resolves inquiries and concerns.
• Meets or exceeds individual performance goals in call quality, attendance, adherence, and other center objectives.
• Proactively engages with internal/external stakeholders and takes ownership of real-time solutioning.
• Supports inquiries involving benefits, claims, premiums, provider portal, member eligibility, and other issues; conducts initial research and resolves issues.
• Evaluates risk criteria and determines escalation path; demonstrates proficiency in at least two lines of business (e.g., Medicaid, Marketplace).
• Manages multiple channels of communication (e.g., Teams, email) timely.
• Understands provider service inquiries related to claims, authorizations, appeals, contracting and credentialing.

Skills

Customer service

Call center

Data processing

Attention to detail

HIPAA compliance

Verbal and written communication

Time management

Education

High school diploma or equivalent

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 specialist to support members and providers across Medicaid, Medicare and Marketplace lines. You will handle inquiries via phone, chat, and email, resolve issues, and document interactions with accuracy.

The role emphasizes first call resolution, empathy-driven communication, and collaboration with internal and external stakeholders in a fast-paced, high-volume environment.