Customer Service Representative – Healthcare

TEKsystems•Brookfield, WI

6h•Hybrid

About The Position

We are seeking a Member Experience Representative to support members, providers, customers, and brokers by answering questions related to coverage, claims, benefits, billing, and authorizations. This role is highly customer-focused and ideal for individuals with healthcare, insurance, and call-center experience who enjoy helping others navigate complex information in a clear and friendly way. You will serve as a trusted resource, working to resolve questions efficiently while striving for first-call resolution and maintaining a high standard of service excellence.

Requirements

2+ years of healthcare customer service or call-center experience
Experience with: Insurance verification, Explanation of Benefits (EOBs), Prior authorizations
Strong verbal and written communication skills
Excellent attention to detail and organizational skills

Responsibilities

Answer inbound phone and email inquiries from members, providers, customers, and brokers regarding: Coverage and benefits, Claim status, Billing questions, Prior authorizations
Investigate member accounts and take appropriate next steps to resolve concerns.
Translate healthcare and insurance terminology into simple, easy-to-understand explanations.
Document all interactions clearly and accurately within internal systems.
Ask probing and clarifying questions during calls to ensure first-call resolution.
Follow up with internal departments or external resources to resolve outstanding issues.
Escalate complex or sensitive issues to a Supervisor or appropriate team when needed.
Adhere to organizational policies, regulatory requirements, and HIPAA standards.
Consistently meet department performance metrics and response time standards.
Demonstrate behaviors aligned with Network Health’s mission, values, and commitment to service.