Two Chicks With A Side Hustle

Molina Healthcare is hiring for several remote Medicare Member Engagement Specialists in our Inbound/Outbound department. 
Bilingual (Spanish) not required but is a plus! This is a 100% remote role. 

This very important customer service role is on our Medicare Concierge team.  This role will be responsible for taking inbound calls from a variety of sources, including but not limited to Members, Providers, and Brokers.  There will also be some outbound calling in this role, as you will need to follow up with Members, Providers, Brokers and other departments. 

This role requires that you be able to deliver a high level of customer service.  Being able to think critically to help solve issues, helping deescalate providers/members issues by providing world call customer service. 

The hours for this role will be 8am to 430pm Monday through Friday. 

Highly qualified applicants will have the following experience:

  • Medicare knowledge/background or solid understanding how health insurance works.
  • Medical knowledge and/or medical background.
  • Behavioral Health experience or any experience in Claims, Billing, Appeals & Grievances, 
  • Strong customer service experience.
  • Excellent communication skills which includes having empathy, and critical thinking skills.
  • Must be intermediate or above using Microsoft Office products- Office, Excel, SharePoint etc.
  • Knowledge of any of the following programs is very helpful- Salesforce, Epic, Clinical Care Advantage, Epic, Genesis, Member 360, QNXT .
  • Must be able to multitask.
  • Bilingual (any language) preferred but not required. Spanish is in high need.
  • Work environment must be free from distractions and secure as you will be working with protected medical information.

Knowledge/Skills/Abilities

  • Responsible for continuous quality improvements regarding member engagement and member retention. Represents Member issues in areas involving member impact and engagement including: New Member Onboarding, member plan benefits education, and the development/maintenance of Member Materials.
  • Conducts direct outreach to new Medicare members to provide personal assistance with their new MAPD, DSNP, and MMP plans. Serves as an advocate to ensure members are well informed about plan benefits, provider options and how to use their new plan benefits.
  • Serve as the member’s navigator during the onboarding process and address any plan questions and anticipate any issues that may arise. Determine the nature of the member’s needs and interests; inform members of their plan resources and benefits with a focus on the member’s area of interest/needs; and follow up with member to ensure needs are met and member is having a positive plan experience.  Develop relationship with member to be the go-to person with any future issues or questions.  
  • Log all contacts in a database.
  • Participate in Member engagement work groups as needed to ensure Medicare member needs are being anticipated and addressed.
  • Participates in regular member benefits training with health plan, including the member advocate/engagement role.

Job Qualifications

REQUIRED EDUCATION:  High School diploma.
PREFERRED EDUCATION: Associate’s or Bachelor’s Degree in Social Work, Human Services, or related field.

REQUIRED EXPERIENCE: 2 years’ experience in customer service, consumer advocacy, and/or health care systems experience conducting intake, interviews, and/or research of consumer or provider issues. Excellent written and verbal communication skills to collaborate internally and externally with members, providers, team members, and manager.  Basic understanding of managed healthcare systems and Medicare.

PREFERRED EXPERIENCE: 2 years’ experience in customer service, consumer advocacy, and/or health care systems. Experience conducting intake, interviews, and/or research of consumer or provider issues. Excellent written and verbal communication skills to collaborate internally and externally with members, providers, team members, and manager.  Experience with Medicare and Medicare managed plans such as MAPD, DSNP, and MMP.

PHYSICAL DEMANDS:
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an 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.

Pay Range: $13.41 – $29.06 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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.

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