Job Description

JOB DESCRIPTION

Job Summary

Provides customer support and stellar service to meet the needs of our Molina members and providers.

Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences. Responsible for continuous quality improvements regarding member/provider engagement and retention. Represents Member/Provider issues in areas involving member/provider impact and engagement including: Appeals and Grievances, Problem Research and Resolution, and the development/maintenance of Member/Provider Materials

Job Duties

• Provide service support to members and/or providers using one or more contact center communication channels and across multiple states and/or products. To include, but not limited to, phone, chat, email, and off phone work supporting our Medicaid, Medicare and/or Marketplace business.

• Assist Members and Providers with a focus on process improvement and retention.

• Consistent delivery of excellent customer service and First Call Resolution.

• Accurate documentation for all calls across multiple platforms.

• Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed

• Demonstrate ability to quickly build rapport and respond to customers in an empathetic manner by identifying and exceeding customer expectations.

• Aptitude to listen attentively, capture relevant information, and identify Member or Provider’s inquiries and concerns.

• Capable of meeting/ exceeding individual performance goals established for the position in the areas of: Call Quality, Attendance, Adherence and other Contact Center objectives.

• Able to proactively engage and collaborate with varies Internal/ External departments.

• Personal responsibility and accountability by taking ownership of providing resolutions in real time or through timely follow up with the Member and/or Provider.

• Supports member and provider for a wide variety of inquiries and assistance involving their benefits, claims, premiums, and other issues. Conducts initial research and works to immediate resolve issues.

• Evaluate risk criteria and determine urgency and appropriate escalation path.

• Proficient in at least two lines of business (e.g., Medicaid, Marketplace).

• Manages multiple channels of communication (e.g., Teams, Jabber) within a timely manner.

• Familiarity with Provider Service inquiries related to: Claims, Authorizations, Appeals, Contracting and Credentialing.

• Acquainted with multiple products such as Medicaid and Marketplace and their enrollment process.

• Ability to conduct thorough research while maintaining coherent conversation with customers.

• Adequate communication skills in a professionally setting.

• Competent in Microsoft Office applications (e.g., Excel, Word, PowerPoint).

Job Qualifications

REQUIRED EDUCATION:

Associate’s Degree or equivalent combination of education and experience

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

1-3 years Sales and/or Customer Service experience in a fast paced, high volume environment

PREFERRED EDUCATION:

Bachelor’s Degree or equivalent combination of education and experience

PREFERRED EXPERIENCE:

3-5 years

Preferred Systems Training:

• Microsoft Office
• Genesys
• Salesforce
• Pega
• QNXT
• CRM
• Verint
• Kronos
• Microsoft Teams
• Video Conferencing
• CVS Caremark
• Availity
• Molina Provider Portal

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Health and Life License

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.

Job Info

Job Identification: 2026922

Job Category: Operations

Posting Date: 2024-07-08T19:31:54 00:00

Job Schedule: Full time