Job Description

JOB DESCRIPTION Job Summary

Leads and directs the team responsible for delivering support center service excellence and executing member retention strategies that strengthen engagement, address barriers, and improve the overall member experience. Ensures member and provider needs are addressed fairly, effectively, and in alignment with Molina values. Demonstrates accountability for service delivery, identifies proactive opportunities to retain members through personalized support, issue resolution, and coordinated outreach, and advances continuous quality improvement initiatives that support engagement, satisfaction, and retention.

Essential Job Duties

• Provides leadership and oversight for the member and provider support center; ensures exemplary service is delivered according to Molina goals/objectives/policies/procedures and regulatory requirements, and demonstrates accountability for performance and financial outcomes.
• Directly leads support center leadership that oversee teams that support servicing of members and providers.
• Demonstrates accountability for ensuring teams deliver effective customer service for all service needs including benefits, claims, billing inquiries, service requests, suggestions and complaints.
• Directly and through team members, resolves both member and provider inquiries and complaints fairly and effectively.
• Provides direction and coordination to deliver accurate product and service information to members and providers, and identifies opportunities to increase membership by improving the member and provider experience.
• Recommends and implements programs to support member and provider needs.
• Works collaboratively within a matrix environment with dotted line relationships across multiple lines of business.
• Works cross collaboratively with other teams and departments.
• Meets and exceeds department key performance indicators (KPIs) including productivity and service quality goals; implements strategies to meet/exceed goals.
• Drives process improvements to ensure performance goals including quality goals are met.
• Participates in audits including state, federal, internal, National Committee for Quality Assurance (NCQA) and Healthcare Effectiveness Data Information Set (HEDIS) as applicable.
• Provides exemplary customer service to all customers including members, co-workers, vendors, providers, government agencies, business partners and the general public.
• Sets a positive example for others and builds the Molina culture by modeling the Molina mission, vision and values in daily actions.
• Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of department-specific goals.
• Models dynamic leadership for support center leadership team and representatives; develops team to focus on delivering great health care/customer service to underserved populations.

Required Qualifications

• At least 8 years of customer service, call center and/or sales experience in a fast-paced/high-volume environment, including 7 years of call center experience, or equivalent combination of relevant education and experience.
• At least 3 years of management/leadership experience.
• Strong customer service skills.
• Understanding of insurance products including Medicaid, Medicare and Marketplace/enrollment processes.
• Organizational and time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
• Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA).
• Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and customers.
• Ability to work cross-functionally across a highly matrixed organization.
• Excellent verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

• Systems training/experience for the following : Microsoft Office, Microsoft Teams, Genesys, Salesforce, Pega, QNXT, CRM, Verint, video conferencing, CVS Caremark, Availity.
• Managed care/health care experience.
• Broker/health insurance license.

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