Representative, Support Center II - Bilingual

Molina HealthcareHealthcare insurance

Source API remote eligibility restrictions: United States, Mon - Fri hours may vary depending on time zoneFull-TimeJunior

Salary not disclosed

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Job Details

Languages: Bilingual; Spanish-language customer support
Experience: At least 1 year of customer service, call center and/or sales experience in a fast-paced/high-volume environment, or equivalent combination of relevant education and experience.
Required Skills: SalesforceMicrosoft OfficeCustomer service

Have at least 1 year of customer service, call center, or sales experience in a fast-paced, high-volume environment, or an equivalent combination of relevant education and experience.
Have customer service skills and data processing experience.
Demonstrate attention to detail, organizational skills, and time-management skills while managing simultaneous tasks.
Maintain confidentiality and comply with HIPAA.
Establish and maintain positive working relationships with coworkers, members, providers, and customers.
Have effective verbal and written communication skills.
Be proficient in Microsoft Office and applicable software programs.
Preferred: Have call center experience and managed care or healthcare experience.
Preferred: Have systems experience or training with Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, CVS Caremark, or Availity.
Preferred: Hold a broker or health insurance license.

Provide member and provider support through phone, chat, email, and administrative off-phone work across multiple states and lines of business.
Research and resolve inquiries involving benefits, claims, premiums, provider portals, member eligibility, and related issues.
Support appeals and grievances, problem resolution, and the development and maintenance of member and provider materials.
Document calls accurately across multiple platforms and manage communications such as Teams and email in a timely manner.
Evaluate risk criteria, determine urgency, and select the appropriate escalation path.
Deliver customer service and first-call resolution while identifying opportunities to improve the member and provider experience.
Build rapport, listen to customers, identify their needs, and provide empathetic assistance and follow-up.
Work with internal and external stakeholders and meet individual goals for call quality, attendance, and schedule adherence.
Demonstrate proficiency in at least two lines of business and respond to provider inquiries about claims, authorizations, appeals, contracting, and credentialing.
Work scheduled shifts, follow lunch and break protocols, and accommodate overtime or weekend work as needed.

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