Representative, Center III

Job Title

Provides level III support center customer service excellence to meet the needs of Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values. Provides product and service information, identifies opportunities to improve the member and provider experience, and supports continuous quality improvement initiatives related to member/provider engagement and retention.

• 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.
• Provides product and service information and identifies opportunities to maintain and increase member/provider relationships and engagement.
• Provides excellent customer service for all support center communication channels.
• 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.
• Proficient in three or more lines of business (Medicare, Medicaid, Marketplace, Medicare-Medicaid Plan (MMP)) - supporting member services, provider services and member retention.
• 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.

• 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…