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Customer Experience Rep III

Passport Health Plan by Molina Healthcare Hazard, Kentucky Job ID 2010782
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Passport Health Plan by Molina Healthcare has a mission to provide quality health care to those who need it, no matter their circumstances. Today, Molina health plans serve 3,331,000 members across the country through government-funded programs. Each day, we work to earn the trust our partners and members put in us, so they can lean on Molina. Together, Passport Health Plan and Molina share a commitment to improving the health and quality of life of our members across the Commonwealth of Kentucky.

  • Full Time, Part Time
  • Level: All Levels
  • Travel: Occassional
  • passport-logo

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Success Profile

What makes you successful at Passport Health Plan by Molina Healthcare? Check out the traits we’re looking for and see if you're the right fit!

  • Compassionate
  • Consultive
  • Patient
  • Problem-Solver
  • Sincere
  • Relationship Expertise

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Benefits

  • Insurance

    Medical · Dental · Vision
    Group & Voluntary Life Insurance
    Aflac · Pet Health · Identity Theft
    Auto & Home Insurance

  • Savings

    Flexible Spending Accounts
    401K · Roth 401K
    Employee Stock Purchase Plan

  • Career Growth

    Continuing Education Units
    Education Reimbursement

  • Time Off

    Paid Time Off
    Volunteer Time Off
    Company Holidays

  • Additional Perks

    Legal Assistance Plan
    Employee Assistance & Well Being Programs
    Employee Perks Platform
    Rideshare Portal

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Responsibilities

KNOWLEDGE, SKILLS & ABILITIES (Generally, the occupational knowledge and specific technical and professional skills and abilities required to perform the essential duties of this job):

  • Responds to incoming calls from members and providers on a variety of issues of varying complexity, including highly complex issues. Also provides product and service information to members, identifies oppportunities to maintain and increase member relationships and engagement.
  • Handles escalated calls on behalf of management.
  • Provides excellent customer service for all inbound and outbound calls.
  • Accurately documents all calls.
  • Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed.
  • Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations.
  • Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the customer’s needs.
  • Supports member needs for a wide variety of inquiries and assistance involving their benefits, claims, premiums, and other areas including very complex issues. Conducts initial research and works to immediately resolve issues. Appropriately escalates issues based on established risk criteria.
  • Supports provider needs for a wide variety of inquiries and assistance involving claims, authorizations, appeals, contracting, credentialing and other areas including the most complex issues. Conducts initial research and works to immediate resolve issues. Appropriately escalates issues based on established risk criteria.
  • Proficient in three or more lines of business (for example, Medicare, Medicaid, Marketplace, MMP)  for members services, provider services and member retention.
  • Responds to incoming calls from providers on a variety of issues of varying complexity, including highly complex or executive issues.
  • Completes research for state, legislative or regulatory inquiries as applicable.
  • Gathers information to critically evaluate options, seeking alternative perspectives to identify root causes and develop solutions.
  • Achieves individual performance goals as it relates to call center objectives.
  • Proctively engages and collaborates with other departments as required.
  • Demonstrates personal responsibility and accountability by meeting or exceeding attendance and schedule adherence expectations.
  • Assists with formal training needs of other employees along with new hire or training classes as needed.
  • Supports provider and member needs for a wide variety of inquiries involving member eligibility, and covered benefits.
  • Provides inquiry assistance involving claims, authorizations, appeals, contracting, credentialing and other provider related issues.
  • Supports other inquiry areas including the most complex issues.
  • Conducts initial research and works to immediately resolve issues.
  • Appropriately escalates issues based on established risk criteria.
  • Recommends and implements programs to support member needs.
  • Resolves member inquiries and complaints fairly and effectively to ensure member retention.
  • Responds to incoming calls from members and providers.
  • Conducts member satisfaction assessment services and other member surveys as applicable and based on business needs
  • Assist other retention or inbound functions as dictated by service level requirements
  • Remains professional & courteous in verbal & written communications, utilizing concise & effective language at all times

 Proficient in systems utilized:

  • Salesforce
  • Pega
  • QNXT
  • CRM
  • Verint
  • Kronos
  • Microsoft Teams
  • Video Conferencing
  • CVS Caremark
  • Availity
  • Molina Provider Portal
  • Others as required by line of business or state

JOB FUNCTION:

Provides customer support and stellar service to meet the needs of our Molina members and providers.

Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences.  Responsible for continuous quality improvements regarding member engagement and member retention.  Represents Member issues in areas involving member impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the development/maintenance of Member Materials

REQUIRED EDUCATION:

Associate’s Degree or equivalent combination of education and experience

REQUIRED EXPERIENCE:

3-5 years customer service or sales experience in a fast paced, high volume environment

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

PREFERRED EDUCATION:

Bachelor’s Degree or equivalent combination of education and experience

PREFERRED EXPERIENCE:

5-7 years

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Broker/Healthcare insurance licensure

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office or home office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full Time Posting Date: 10/14/2021

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