Representative, Support Center III

JOB DESCRIPTION Job Summary 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. Essential Job Duties u2022 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. u2022 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. u2022 Provides product and service information and identifies opportunities to maintain and increase member/provider relationships and engagement. u2022 Provides excellent customer service for all support center communication channels. u2022 Handles escalated calls on behalf of leadership. u2022 Accurately documents all member/provider communications. u2022 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. u2022 Quickly builds rapport and responds to customers in a compassionate manner by identifying and exceeding customer expectations. u2022 Listens skillfully, collects relevant information, determines immediate requests and identifies the customeru2019s needs. u2022 Achieves individual performance goals established in the areas of call quality, attendance, scheduled adherence and call center objectives. u2022 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. u2022 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. u2022 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. u2022 Gathers information to critically evaluate options, seeking alternative perspectives to identify root causes and develop solutions. u2022 Proficient in three or more lines of business (Medicare, Medicaid, Marketplace, Medicare-Medicaid Plan (MMP)) - supporting member services, provider services and member retention. u2022 Completes research for state, legislative or regulatory inquiries as applicable. u2022 Conducts member satisfaction assessment services and other member surveys as applicable and based on business needs. u2022 Assists other retention or inbound functions as dictated by service level requirements. u2022 Remains professional and courteous in verbal and written communications - utilizing concise and effective language at all times. u2022 Professionally engages and collaborates with other departments as needed. u2022 Provides training and support to new and existing support center representatives. Required Qualifications u2022 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. u2022 Understanding of insurance products including Medicaid, Medicare and Marketplace/enrollment processes. u2022 Customer service skills, including ability to conduct thorough research while maintaining coherent conversation with customers. u2022 Data processing experience. u2022 Attention to detail, organizational and time-management skills, and ability to manage simultaneous tasks to meet business needs. u2022 Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA). u2022 Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and customers. u2022 Effective verbal and written communication skills. u2022 Proficiency in Microsoft Office suite and applicable software programs. Preferred Qualifications u2022 Systems training/experience for the following : Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing, CVS Caremark, Availity. u2022 Call center experience. u2022 Managed care/health care experience. u2022 Broker/health insurance license. #PJCC2 #LI-AC1 To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $34.88 / HOURLY Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2026-04-13