Rep, Customer Experience II

$33,280 - $54,954/Yr

Molina Healthcare - El Cajon, CA

Full-time - Entry Level

El Cajon, CA

Insurance Carriers and Related Activities

About the position

The Customer Experience Representative II at Molina Healthcare is a pivotal role that focuses on delivering exceptional customer support and service to both members and providers. This position is designed to meet the diverse needs of Molina's clientele, ensuring that issues are resolved effectively and efficiently while embodying the core values of the organization. The representative will be responsible for providing comprehensive product and service information, identifying opportunities for enhancing member and provider experiences, and driving continuous quality improvements in member and provider engagement and retention. In this role, the representative will engage with members and providers through various communication channels, including phone, chat, and email, across multiple states and product lines such as Medicaid, Medicare, and Marketplace. The representative will be tasked with assisting members and providers, focusing on process improvement and retention, while consistently delivering excellent customer service and achieving First Call Resolution. Accurate documentation of all interactions across multiple platforms is essential, as is the ability to work scheduled shifts, including potential overtime and weekends. The representative will also be expected to build rapport with customers, respond empathetically to their needs, and proactively engage with internal and external departments to resolve issues. This includes supporting inquiries related to benefits, claims, premiums, and other concerns, conducting initial research, and determining the urgency of issues for appropriate escalation. Proficiency in at least two lines of business is required, along with the ability to manage multiple communication channels effectively. Familiarity with provider service inquiries and various products is also essential for success in this role.

Responsibilities

• Provide service support to members and/or providers using various contact center communication channels.
• Assist Members and Providers with a focus on process improvement and retention.
• Deliver excellent customer service and achieve First Call Resolution consistently.
• Document all calls accurately across multiple platforms.
• Work scheduled shifts, including overtime and weekends as needed.
• Build rapport and respond empathetically to customers, identifying and exceeding their expectations.
• Listen attentively and capture relevant information to address Member or Provider inquiries and concerns.
• Meet or exceed individual performance goals in Call Quality, Attendance, Adherence, and other objectives.
• Engage and collaborate proactively with internal and external departments.
• Take ownership of providing resolutions in real time or through timely follow-up with Members and/or Providers.
• Support members and providers with inquiries involving benefits, claims, premiums, and other issues.
• Conduct initial research and work towards immediate resolution of issues.
• Evaluate risk criteria and determine urgency and appropriate escalation paths.
• Manage multiple channels of communication within a timely manner.
• Familiarity with Provider Service inquiries related to Claims, Authorizations, Appeals, Contracting, and Credentialing.

Requirements

• Associate's Degree or equivalent combination of education and experience.
• 1-3 years of Sales and/or Customer Service experience in a fast-paced, high-volume environment.

Nice-to-haves

• Bachelor's Degree or equivalent combination of education and experience.
• 3-5 years of experience in a similar role.
• Preferred Systems Training: Microsoft Office, Genesys, Salesforce, Pega, QNXT CRM, Verint, Kronos, Microsoft Teams, Video Conferencing, CVS Caremark, Availity, Molina Provider Portal.
• Health and Life License.

Benefits

• Health insurance