Representative, Support Center II (Bilingual English/Spanish)

Molina Healthcare; North Olmsted (OH); Hybrid; USD 21,000 - 36,000; Full time

Job summary

Molina Healthcare is seeking a customer service representative to support members and providers across multiple states via phone, chat, and email. You will handle inquiries related to benefits, claims, and eligibility while maintaining HIPAA standards and delivering first-contact resolution.

The role requires strong communication skills, attention to detail, and proficiency with common software tools. Flexible shifts may include overtime to support operations.

Qualifications

• 1+ year of customer service or call center experience in a fast paced environment.
• Strong customer service and communication skills.
• Data processing experience and attention to detail.
• Ability to maintain confidentiality per HIPAA.
• Proficiency with Microsoft Office and related software.

Responsibilities

• Provide service support to members/providers across multiple channels.
• Handle appeals, grievances, and document interactions accurately.
• Assist with issue resolution and process improvement.
• Deliver excellent customer service and first contact resolution.
• Document calls across platforms and manage workload to meet goals.
• Collaborate with stakeholders and escalate as needed.

Skills

Customer service

Communication

Data processing

Attention to detail

HIPAA compliance

Microsoft Office

Tools

Microsoft Office

Teams

Genesys

Salesforce

Pega

QNXT

Verint

CRM

Job description

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: $15.4 - $26.42 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.