Representative, Support Center Ii

Molina Healthcare; Cincinnati (OH); Sur place; USD 17 000 - 30 000; Plein temps

Avantages offerts par ce poste

Competitive benefits

Résumé du poste

Molina Healthcare is seeking an empathetic and detail-oriented Customer Service Associate in Cincinnati, OH to deliver level II support for members and providers. You will handle calls, chats, and emails, resolve issues, and guide customers through benefits, claims, and portal access.

You will document all interactions accurately, collaborate with stakeholders, and meet performance targets while maintaining confidentiality and HIPAA compliance.

Qualifications

• 1+ year of customer service or call center experience in a high-volume setting.
• Strong data handling and documentation abilities.
• Ability to protect confidentiality and follow HIPAA rules.
• Effective verbal and written communication skills.

Responsabilités

• Provide level II support to Molina members and providers across multiple states.
• Handle inquiries via phone, chat, and email and document interactions accurately.
• Resolve issues, support retention, and improve member/provider experience.
• Escalate complex cases and collaborate with internal/external teams as needed.
• Maintain adherence to schedules, attendances, and quality metrics.
• Take ownership of real-time problem solving and follow-up.

Connaissances

Customer service

Communication skills

Data processing

HIPAA compliance

Time management

Outils

Microsoft Office

Microsoft Teams

Genesys

Salesforce

Pega

QNXT

Verint

Description du poste

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

Pay Range: $11.55 - $22.32 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.