Representative, Support Center II - Remote

Molina Talent Acquisition; Arizona; Remote; USD 40,000 - 48,000; 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 calls, chats, and emails, document interactions, and work toward first-call resolution.

Qualifications include 1+ year in customer service, strong communication skills, attention to detail, and HIPAA compliance. Proficiency in Microsoft Office and CRM tools is preferred.

Qualifications

• At least 1 year of customer service in a fast-paced environment.
• Strong data processing and attention to detail.
• Confidentiality and HIPAA compliance.
• Effective verbal and written communication skills.
• Proficiency with Microsoft Office suite.

Responsibilities

• Provide service support via phone, chat and email across multiple states/products.
• Document calls accurately across platforms and strive for first call resolution.
• Escalate issues per protocol and coordinate with internal/external stakeholders.
• Demonstrate empathy, build rapport and meet performance goals.
• Assist members and providers with benefits, claims and eligibility inquiries.

Skills

Customer service

Communication skills

Attention to detail

HIPAA compliance

Multitasking

Tools

Microsoft Office

Microsoft Teams

Genesys

Salesforce

Pega

QNXT

CRM

Verint

Job description

Mon - Fri 8am -4:30pm. Hours depends on your time zone

JOB DESCRIPTION Job Summary

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.

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