Representative, Support Center III

Job Summary

About the role

Provides level III support center customer service excellence to meet the needs of Molina members and providers.

Responsibilities

• Serves 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.
• Sets up and resolves 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.
• 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.
• Provides product and service information and identifies opportunities to maintain and increase member/provider relationships and engagement.
• Handles escalated calls on behalf of leadership.
• Accurately documents all member/provider communications.
• 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 a compassionate manner by identifying and exceeding customer expectations.
• Listens skillfully, collects relevant information, determines immediate requests and identifies the customer’s needs.
• Achieves individual performance goals established in the areas of call quality, attendance, scheduled adherence and call center objectives.
• Demonstrates personal responsibility and accountability by taking ownership of the customer's call/issue and following through to resolution in real-time or via expeditious follow-up.
• Supports a wide variety of member and provider inquiries involving eligibility, benefits, claims, premiums, authorizations, appeals, contracting, credentialing, and other issues; conducts initial research and works to immediately resolve issues; appropriately escalates issues based on established risk criteria.
• Responds to incoming calls from providers on a variety of issues of varying complexity, including highly complex or executive issues, and demonstrates understanding of provider service inquiries related to claims, authorizations, appeals, contracting and credentialing.
• Gathers information to critically evaluate options, seeking alternative perspectives to identify root causes and develop solutions.
• Completes research for state, legislative or regulatory inquiries as applicable.
• Conducts member satisfaction assessment services and other member surveys as applicable and based on business needs.
• Assists other retention or inbound functions as dictated by service level requirements.
• Remains professional and courteous in verbal and written communications - utilizing concise and effective language at all times.
• Professionally engages and collaborates with other departments as needed.
• Provides training and support to new and existing support center representatives.

Requirements

• At least 2 years of customer service, call center and/or sales experience in a fast-paced/high-volume environment, or equivalent combination of relevant education and experience.
• Understanding of insurance products including Medicaid, Medicare and Marketplace/enrollment processes.
• Customer service skills, including ability to conduct thorough research while maintaining coherent conversation with customers.
• 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.

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.