Posting Title Member Services Representative III Category Call Center State and City IL-Oak Brook State Illinois (IL) Office Location MIL Oak Brook Employee Status 1-Staff Full Time Auto req ID 10048BR Positions Remaining 1 Job Description Job SummaryRespond to telephone inquiries from both Molina Members and Providers and provide accurate, efficient, and courteous service. Essential Functions • Respond to incoming calls from members and providers required for meeting departmental goals and individual performance metrics. • Achieve individual performance goals as it relates to call center objectives • Engage and collaborate with other departments as applicable • Comply with workplace safety standards • Proficient in discussion and execution of Molinas policies and procedures in accordance with regulatory requirements • Demonstrate positive working relationships with peers and effectively manage conflict • Attend meetings and training sessions as scheduled • Show flexibility in meeting changing performance objectives consistent with Molina and department objectives • Seek out work during slow times to help ensure that department goals are met • Assist with formal training needs of new employees as needed • Takes responsibility for keeping up-to-date and develops skills to meet new needs Pursues learning opportunities to develop and broaden skill set and expertise • Gathers information to critically evaluate options, seeking alternative perspectives to identify root causes and develop solutions • Handles escalated calls on behalf of management • Completes research for state, legislative or regulatory inquiries as applicable within established timelines • Processing pending guardianship documentation received from members and coordinating an approval with corporate compliance via the Champ(Health Plan) system • Responsible for processing simple claim adjustments as specified • Supports Q&A for the department and other responsibilities as needed State Plan / Department Specific Duties and Responsibilities (List all essential duties other than those listed above in order of importance) • Accurately record all calls in QNXT as applicable • Responds to internal and external customers in a timely and accurate manner, treating them with respect and courtesy • Advise callers of outstanding HEDIS services needed • Advise callers with Web Portal registration and utilization • Ad hoc requests for member materials • Process Check Tracers requests • Conduct member satisfaction assessment services as applicable and based on business needs Knowledge/Skills/Abilities• Excellent oral and written communication skills • Ability to use PC, typing 40 WPM • Ability to research problems • Ability to talk and type simultaneously • Strong listening skills • Empathy/passion for working with senior, disabled, low income populations and providers • Exceptional Interpersonal Communication Skills; Superior Verbal and Written communication skills, organizational skills, Problem Solving and Analytical Ability • Bilingual communication skills preferred • Strong knowledge of claims processing and adjustments • Ability to abide by Molina’s policies • Ability to maintain attendance to support required quality and quantity of work • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) • Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers Job Qualifications Required Education: High School Diploma or GED Required Experience: • Minimum 3 years Customer Service/Call Center experience in Healthcare or equivalent related experience • Working knowledge of Microsoft Office or other comparable software • Comprehensive experience of claim processing guidelines • Medical terminology, CPT and ICD-9, ICD-10 coding knowledge/understanding Required Licensure/Certification: N/A Preferred Education: N/A Preferred Experience: • Experience in social services, chemical dependency services, and/or mental healthcare • Working knowledge of medical insurance billing practices • Working knowledge of the State Medicaid programs Preferred Licensure/Certification: N/A Additional Description To all current Molina employees if you are interested in applying for this position please apply through the intranet job listing. Also, fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online. Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Posted on: Wed, 01 Oct 2014 03:21:00 +0000
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