Representative, Support Center Ii

Molina Healthcare; Las Cruces (NM); On-site; USD 30,000 - 42,000; Full time

Job summary

Molina Healthcare is seeking a courteous, detail-oriented Customer Service professional to support members and providers across Medicaid, Medicare, and Marketplace lines in a fast-paced environment.

The role emphasizes first-call resolution, accurate documentation, and proactive escalation when needed, with a focus on collaboration across teams and adherence to Molina values.

Qualifications

• Minimum 1 year of customer service or call center experience in a fast-paced or high-volume environment.
• Strong customer service skills with the ability to communicate clearly.
• Data processing experience and attention to detail.
• Ability to maintain confidentiality and comply with HIPAA.
• Excellent verbal and written communication skills.
• Proficient in Microsoft Office suite and related software.

Responsibilities

• Provide level II support center service to Molina members and providers via multiple channels.
• Handle member/provider issues including appeals, grievances, and information materials.
• Focus on process improvement and retention of members/providers.
• Deliver consistent first-call resolution and accurate documentation across platforms.
• Adhere to scheduled shifts, breaks, and overtime as needed.
• Engage with internal/external stakeholders to resolve inquiries and concerns.
• Understand provider service inquiries related to claims, authorizations, and credentialing.

Skills

Customer service

Data processing

Attention to detail

HIPAA

Communication skills

Time management

Tools

Microsoft Office

Genesys

Salesforce

Pega

QNXT

CRM

Verint

Availity

Job description

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.

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Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $21.78 - $30.39 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.