Job Description

Job Summary

Provide prospective and existing members with assistance (telephonically inbound and outbound) completing state required applications, for the purpose of obtaining and maintaining healthcare coverage, and accurate information for eligibility for Medicaid, CHP and Essential Plan. Provide non-clinical reminders (i.e.; product overviews, premiums, gaps in care, care management, member engagement events etc..) and assist as needed with resolving issues, scheduling appointments, conducting outreach to appropriate State entities and resources to ensure member satisfaction, retention initiatives and quality metrics are met. 

 

Job Duties

• Pro-actively facilitate outreach (and handle inbound calls) to Molina members regarding their upcoming recertification with the state and healthplan. Educating members on process, qualifications, necessary documentation needed etc; while completeing the required applications and submissions to the State.
• Management of individual State dashboards required
• Assist and resolve complex member issues related to application errors, immigration status, multi-family enrollment, premiums, eligibility; etc.
• Provide non-clinical reminders (i.e. product overviews, premiums, gaps in care, member engagement events etc.)
• Facilitate the closure of at-risk care gaps, scheduling appointments, conducting outreach to appropriate State entities, direct toward available resources and care management opportunities; to ensure member satisfaction, retention, and drive plan quality performance.
• Responsible for promoting and increasing member enrollments into plan programs (i.e.; Member portal, Rewards Program, etc.)
• Assists Medicaid Members in contacting their social worker regarding eligibility issues and follow-up with members to ensure follow through, if allowed by the member’s respective state.
• Conduct outreach to retain members that have been identified as late renewals, post terms and potential disenrollments, assist and educate members on next steps and required paperwork.
• Accurately and timely documentation of outreach in the appropriate databases. 
• Collaborate with the leadership team to provide feedback, trends and insights for areas of opportunity for improvement related to technology, process, people, retention and member experience. 
• Access a number of organizational based platforms and tools for the purpose of inputting and outputting data, related to documenting member care, status, renewal status etc. (such as: Salesforce, CCA, Sharepoint, Excel, Genesys etc)
• Attend and assist with in-person community based member retention events
• Placement in demonstrated high foot traffic locations, to assist with member in-person interactions may be required. Assist with in-person renewals, eligibility issues, application updates, submission of paperwork etc..
• Maintain appropriate certifications and quality scores in compliance with the State and Molina Healthcare.
• Some in office trainings, meetings and field work required; will be based on business needs
• Other tasks or special projects  as required or directed

 

Job Qualifications

REQUIRED EDUCATION:

High School Diploma or equivalent

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• 2-4 years customer service experience, preferably in a call center environment 
• Experience communicating with members in a customer service setting and have the ability to assess needs and make thoughtful decisions to help a member

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

Must have NYS Certified Application Counselor Certification and/or be able to obtain certification within 60 days of hire date

PREFERRED EDUCATION:

Associate’s Degree or equivalent combination of education and experience

PREFERRED EXPERIENCE:

3-5 years customer service experience in a call center environment

 

 

 

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.