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. Also provides product and service information, identifies opportunities to maintain and increase member/provider relationships and engagement.
• Handles escalated calls on behalf of management.
• Provides excellent customer service for all call center communication channels.
• Accurately documents all member/provider communication
• 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.
• Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations.
• Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the customer’s needs.
• Achieves individual performance goals established for this position in the areas of call quality, attendance and scheduled adherence.
• Engages and collaborates with other departments.
• Demonstrates personal responsibility and accountability by taking ownership of the call/ issue and following it through to resolution, on behalf of the customer, in real time or through timely follow up with the customer.
• Supports member needs for a wide variety of inquiries and assistance involving their benefits, claims, premiums, and other areas including very complex issues. Conducts initial research and works to immediately resolve issues. Appropriately escalates issues based on established risk criteria.
• Supports provider needs for a wide variety of inquiries and assistance involving claims, authorizations, appeals, contracting, credentialing and other areas including the most complex issues. Conducts initial research and works to immediate resolve issues. Appropriately escalates issues based on established risk criteria.
• Proficient in three or more lines of business (for example, Medicare, Medicaid, Marketplace, MMP) for members services, provider services and member retention.
• Responds to incoming calls from providers on a variety of issues of varying complexity, including highly complex or executive issues.
• Completes research for state, legislative or regulatory inquiries as applicable.
• Gathers information to critically evaluate options, seeking alternative perspectives to identify root causes and develop solutions.
• Achieves individual performance goals as it relates to call center objectives.
• Proactively engages and collaborates with other departments as required.
• Demonstrates personal responsibility and accountability by meeting or exceeding attendance and schedule adherence expectations.
• Assists with formal training needs of other employees along with new hire or training classes as needed.
• Supports provider and member needs for a wide variety of inquiries involving member eligibility, and covered benefits.
• Provides inquiry assistance involving claims, authorizations, appeals, contracting, credentialing and other provider related issues.
• Supports other inquiry areas including the most complex issues.
• Conducts initial research and works to immediately resolve issues.
• Appropriately escalates issues based on established risk criteria.
• Recommends and implements programs to support member needs.
• Resolves member inquiries and complaints fairly and effectively to ensure member retention.
• Responds to incoming calls from members and providers.
• Conducts member satisfaction assessment services and other member surveys as applicable and based on business needs
• Assist other retention or inbound functions as dictated by service level requirements
• Remains professional & courteous in verbal & written communications, utilizing concise & effective language at all times.
Job Qualifications
REQUIRED EDUCATION :
Associate’s Degree or equivalent combination of education and experience
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :
3-5 years customer service or sales experience in a fast paced, high volume environment
PREFERRED EDUCATION :
Bachelor’s Degree or equivalent combination of education and experience
PREFERRED EXPERIENCE :
5-7 years
Proficient in systems utilized:
- Microsoft Office
- Genesys
- Salesforce
- Pega
- QNXT
- CRM
- Verint
- Kronos
- Microsoft Teams
- Video Conferencing
- CVS Caremark
- Availity
- Molina Provider Portal
- Others as required by line of business or state
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION :
Broker/Healthcare insurance licensure
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: 2030144
Job Category: Operations
Posting Date: 2025-03-05T23:21:25 00:00
Job Schedule: Full time
