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Molina Healthcare Lead Rep, Enrollment in United States


  • Perform quality assurance checks on the eligibility monthly, weekly, and daily files processed by the Corporate IS department. Duties include ensuring that all member eligibility, PCP assignments and month end reports are processed timely. Ensure that all month end reports are error free.

  • Perform daily troubleshooting functions to support enrollment, disenrollment, and call center activities.

  • Oversees the daily process of disenrollments and enrollments for capitation and recoupment of funds submitted to Finance. Responsible for reporting discrepancies in enrollment to ensure proper DCH payments to Plan.

  • Assist in the hiring and training of new staff. Assure that all staff is properly trained according to all departmental policies and procedures. Provide ongoing training to staff as needed.

  • Define, monitor, and report to management the performance and productivity standards specific to enrollment systems and processes.

  • Maintain effective communication and interpersonal relationships with internal, external, and corporate staff and departments to ensure efficiency in operations related to enrollment/disenrollment functions.

  • Maintain enrollment performance within established parameters.

  • Other tasks as assigned related to Member Services, to include participation on internal workgroups related to enrollment services.

  • Coordinates enrollment and/or disenrollment processes while ensuring the appropriateness of internal and external rules and regulations for enrolling and/or disenrolling members.

  • Perform various data audits to ensure quality, data integrity and database accuracy.

  • Knowledge of Managed care rules, regulations, and benefits

  • Ability to lead in a manner to ensure that tasks are done by others

  • Ability to multi-task

  • High computer literacy and problem-solving skills

  • Team oriented with a great sense of customer focus

  • Excellent verbal and written communication skills

  • 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.


Required Education

  • High School Diploma

  • Associates Degree

Required Experience

  • 2+ years of customer service experience in managed care environment.

  • Lead experience preferred, will be considered in lieu of actual supervisory experience.

  • 1+ years’ experience working with Medicaid program and working knowledge of guidelines, benefits, enrollment processes.

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