Representative, Support Center II (Bilingual English/Spanish)

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

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