Mid Level Member Support Specialist Jobs

Molina of Ohio is hiring for a Senior Specialist, Member Engagement, who will be handling the analysis and review of our members Value Added Benefits. This role is remote, however applicants must reside in Ohio.

This role is responsible for continuous quality improvements regarding member engagement and member retention. You will represent member perspective in areas involving member impact and engagement. Oversees, tracks, and reports on value-added benefits for Medicaid and MyCare Ohio.

Ideal candidates will demonstrate:

• Critical Thinking & Problem-Solving: Ability to think beyond the surface, ask thoughtful questions, identify root causes, and develop creative, strategic solutions.
• Comfort with Ambiguity: Ability to navigate uncertainty, work independently with limited direction, and adapt as priorities and information evolve.
• Initiative & Ownership: A self-starter who takes initiative, digs into challenges, follows through on commitments, and proactively seeks answers.
• Data Analysis & Storytelling: Demonstrated experience reviewing, analyzing, and interpreting data and complex datasets. Must be able to digest large amounts of information, identify trends, patterns, and potential gaps, and connect the dots to tell a clear, meaningful story. Ability to translate data into actionable insights, explain the "why" behind the numbers, and communicate findings that support strategic business decisions.
• Analytical Skills: Hands-on experience reviewing dashboards, evaluating performance metrics, and combining quantitative data with qualitative feedback to identify opportunities, uncover root causes, and recommend solutions.
• Advanced Excel Proficiency: Strong Excel skills are essential, including the ability to organize, analyze, and interpret complex data.
• Strategic & Creative Thinking: Ability to connect the dots, challenge assumptions, ask the right questions, and identify opportunities for improvement.
• Communication & Collaboration: Strong communication skills with the confidence and curiosity to ask questions, seek clarification, and engage stakeholders to drive results.

Smartsheet Experience: Preferred but not required

Essential Job Duties

• Provides senior level support for member engagement and member retention activities. Represents members in areas involving member impact and engagement including: appeals and grievances and member issue research and resolution. Provides new and existing members with the best possible service in relation to billing inquiries, service requests, suggestions and complaints. Resolves member inquiries and complaints fairly and effectively. Provides product and service information to members, and identifies opportunities to maintain and increase member relationships. Recommends and implements programs to support member needs, and develops/maintains member materials.
• Provides direct telephonic assistance to members and/or member family members seeking to resolve complex issues or complaints; seeks to engage and retain new and existing members.
• Ensures enrollee's rights are upheld and helps enrollees understand their rights and benefits in working through the system.
• Assists members in the complaint and appeal process internally and at the state level; determines the nature of the member's needs or problem; informs members of their rights in the complaints and appeals process; advises/refers as appropriate for investigation and resolution, and monitors outcomes
• Serves as an advocate in collaboration with providers, regulatory agencies, outside agencies, colleagues and other functional departments as appropriate.
• Educates members on covered services available to them, including preventive services.
• Provides support to enrollees and providers in provision of plan benefits.
• Educates members on covered services available, including preventive services.
• Provides information, guidance and assistance over the phone or in person to members with disabilities who call for help related to plan participation; analyzes internal system functions that affect enrollee access to medical care and quality of care.
• Investigates and resolves access and cultural sensitivity issues identified by the enrollee, care management staff, the state, providers, advocate organizations, and subcontractors.
• Monitors all formal and informal grievances in collaboration with the appeals and grievances team; identifies trends or problem areas of member access and care delivery.
• Provides timely written responses to member inquiries; prepares written analyses of advocacy issues, and assists with documentation preparation for appeals, fair hearings or other formal/informal dispute resolution processes.
• Collaborates with the care management team to support resolution of member issues/concerns; ensures that trends are identified and solutions outlined.
• Conducts focus groups in service delivery area as needed to ensure member needs are being addressed.
• Supports ongoing member advocacy training and disseminates member advocacy educational materials to internal staff, providers, and subcontractors
• Serves as a resource for Molina staff and members with regard to partnering community agencies, services and referrals for special needs, Medicaid benefits, and other related needs.
• Participates in the statewide advocacy program for the plan; collaborates with the state external advocate, enrollment specialists and ombudsmen on issues of access to medical care, quality of care, enrollment and disenrollment.
• Conducts in person meetings with members and/or family members as appropriate.
• Participates in internal quality assurance and improvement committees to ensure services to enrollees are provided in accordance with all state/plan requirements.
• Accurately and timely documents member contacts/cases in appropriate database.
• Provides training and support to new and existing member engagement and retention team members.

Required Qualifications

• At least 3 years of experience in member services, member outreach, community engagement, consumer advocacy, or customer service in managed care or health care setting, and at least 1 year of experience working with underserved populations - preferably within a Medicaid environment, or equivalent combination of relevant education and experience.
• Effective interpersonal skills, with a customer-first mindset.
• Experience conducting intake, interviews, and/or research of consumer or provider issues.
• Understanding of managed health care systems and behavioral health issues.
• Ability to work both independently and as part of a team in a fast-paced environment.
• Ability to assess needs and make thoughtful decisions to support members.
• Time-management and organizational skills.
• Ability to work cross-functionally within a highly matrixed organization.
• Effective verbal and written communication skills, and professional telephone etiquette skills.
• Microsoft Office suite/applicable software program(s) proficiency

Preferred Qualifications

• Managed care experience.
• Call center experience.

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

Pay Range: $18.04 - $35.17 / HOURLY

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.