Representative, Support Center II (Bilingual English/Spanish)

Job Description

• Level II bilingual English/Spanish support center representative serving Molina members and providers across Medicaid, Medicare, and Marketplace lines of business.
• Provides phone, chat, email, and administrative support; researches and resolves inquiries involving benefits, claims, premiums, eligibility, provider portals, authorizations, appeals, contracting, and credentialing.
• Handles appeals and grievances, risk evaluation, escalation, call documentation, first-call resolution, and timely member/provider follow-up.
• Requires at least 1 year of customer service, call center, and/or sales experience in a fast-paced, high-volume environment, HIPAA compliance, Microsoft Office proficiency, and effective communication skills.
• Preferred experience includes managed care/healthcare, call centers, a broker/health insurance license, and systems including Teams, Genesys, Salesforce, Pega, QNXT, Verint, CVS Caremark, and Availity.