Member Services Associate II

1 week ago

Sacramento, California, United States Molina Healthcare Full time

JOB DESCRIPTION

Customer Experience Representative II (Onsite position)

Job Overview

This role is dedicated to delivering exceptional in-person support and service at the Molina Healthcare Help Center, addressing the needs of our members and providers effectively.

Join a team that is passionate about making a significant difference in the community by engaging with our Members and Providers directly. This position provides an opportunity to enhance community health by linking individuals and families with vital resources and services.

The representative will resolve issues and meet needs in a fair and effective manner, embodying Molina values in every interaction. Responsibilities include providing information about products and services while identifying opportunities to enhance the experiences of our members and providers. The role also involves continuous quality improvement efforts related to member/provider engagement and retention. Key responsibilities include representing member/provider concerns in areas such as Appeals and Grievances, Problem Research and Resolution, and the creation and maintenance of Member/Provider Materials.

Key Responsibilities


• Deliver in-person service support to members and/or providers through various communication channels, including phone, chat, and email, across multiple states and products.


• Assist the Molina Help Center in providing enrollment assistance and a variety of local services, including housing support and food security.


• Support Members and Providers both in person and via phone, focusing on process enhancement and retention.


• Ensure consistent delivery of high-quality customer service and First Call Resolution.


• Maintain accurate documentation for all interactions across various platforms.


• Work scheduled shifts within operational hours, including potential overtime and weekend work as necessary.


• Demonstrate the ability to build rapport quickly and respond to customers empathetically, aiming to exceed their expectations.


• Listen attentively, capture relevant information, and identify inquiries and concerns from Members or Providers.


• Meet or exceed individual performance targets related to Call Quality, Attendance, Adherence, and other objectives.


• Engage proactively and collaborate with various internal and external departments.


• Take personal responsibility for providing resolutions in real-time or through timely follow-up with Members and/or Providers.


• Assist members and providers with a wide range of inquiries regarding their benefits, claims, premiums, and other issues, conducting initial research to resolve problems.


• Assess risk criteria and determine urgency and appropriate escalation paths.


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


• Manage multiple communication channels effectively.


• Have familiarity with Provider Service inquiries related to Claims, Authorizations, Appeals, Contracting, and Credentialing.


• Understand multiple products such as Medicaid and Marketplace and their enrollment processes.


• Conduct thorough research while maintaining coherent conversations with customers.


• Exhibit adequate communication skills in a professional environment.


• Be 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 of experience in Sales and/or Customer Service in a fast-paced, high-volume environment.

PREFERRED EDUCATION :

Bachelor's Degree or equivalent combination of education and experience.

PREFERRED EXPERIENCE :

3-5 years of experience, bilingual in English/Spanish.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION :

Health and Life License.

About Us

Molina Healthcare is a nationwide Fortune 500 organization committed to providing quality healthcare to individuals receiving government assistance. We seek dedicated individuals who are eager to contribute to a team-oriented environment. Join us in making a difference in the lives of others while enjoying a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full Time

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