Sr Specialist, Medicare Member Engagement (Remote)

Lensa; Mesa (AZ); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare company is looking for a Sr. Specialist in Medicare Member Engagement. This remote role focuses on monitoring and evaluating member interactions to ensure quality standards. Responsibilities include call evaluations, feedback delivery, and collaboration with training teams to enhance performance. The ideal candidate has a high school diploma and 3 years of relevant customer service experience, particularly in quality assurance or healthcare systems. Join a passionate team committed to community outreach and empowerment.

Qualifications

• 3 years’ experience in customer service with a focus on quality assurance.
• Excellent written and verbal communication skills.

Responsibilities

• Monitor and evaluate calls to assess agent performance.
• Provide feedback to agents and team leaders.
• Document evaluation results and present findings.

Skills

Communication

Problem Solving

Education

High School Diploma

Associate or bachelor's degree in social work

Tools

Microsoft Office Suite

Genesys

QNIXT

Marx Incomm

WEX

Job description

Molina Healthcare

Sr Specialist, Medicare Member Engagement (Remote)

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The Sr. Specialist Member Engagement representative is responsible for monitoring and evaluating member interactions to ensure that the concierge agents adhere to established quality standards. The role involves reviewing call recordings, providing feedback to agents, and collaborating with team leaders to enhance call quality.

Job Duties

Monitor and Evaluate Calls: Listen to and review Concierge call interactions to assess agent performance against quality standards, including communication skills, adherence to scripts, problem-solving ability, and overall customer service quality.

Provide Feedback: Deliver constructive feedback to agents and team leaders, highlighting strengths and identifying areas for improvement. Work with agents to implement strategies for enhancing performance.

Report and Document Findings: Accurately document evaluation results, creating detailed reports that capture key insights and trends. Present findings to management and make recommendations for training and development.

Collaborate with Training Teams: Work closely with training teams to develop and implement training programs that address areas of improvement identified during call monitoring.

Ensure Compliance: Ensure that all interactions follow company policies, procedures, and regulatory requirements. Report any breaches or potential risks to the appropriate authorities.

Identify Process Improvements: Identify trends in customer interactions and recommend process improvements to enhance overall customer satisfaction and operational efficiency.

Support Continuous Improvement: Participate in quality assurance calibration sessions with team leaders and management to ensure consistency in evaluation standards.

Stay Updated: Keep up to date with industry best practices and emerging trends in quality assurance and customer service.

Job Qualifications

REQUIRED EDUCATION:

High School Diploma or equivalency

REQUIRED EXPERIENCE:

3 years’ experience in customer service with a focus on quality assurance or customer service, consumer advocacy, and/or health care systems.

Experience conducting intake, interviews, and/or research of consumer or provider issues.

Excellent written and verbal communication skills to collaborate internally and externally with members, providers, team members, and manager.

Basic understanding of managed healthcare systems and Medicare.

PREFERRED EDUCATION:

Associate or bachelor’s degree in social work, Human Services, or related field.

PREFERRED EXPERIENCE:

Experience with Medicare and Medicare managed plans such as MAPD, DSNP, and MMP.

Strong problem-solving skills.

Excellent verbal and written communication skills.

Ability to provide constructive feedback in a positive and professional manner.

Detail-oriented with strong organizational skills.

Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Teams, Outlook) and quality monitoring tools.

Applications: Genesys, QNIXT, Marx Incomm, WEX

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

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

Pay Range: $21.16 - $42.2 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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Job Summary The Sr. Specialist Member Engagement representative is responsible for monitoring and evaluating member interactions to ensure that the concierge agents adhere to established quality standards. The role involves reviewing call recordings, providing feedback to agents, and collaborating...