Member Experience Representative I

Network Health WI•Menasha, WI

7d•Hybrid

About The Position

The Member Experience Representative I will support Network Health's various lines of business by addressing benefit interpretations, claims, authorizations, and other member inquiries in a collaborative and innovative environment. This role involves assisting members with their healthcare questions through phone calls and emails, as well as supporting providers with inquiries about Network Health plans. Member Experience Representatives embody the company's commitment to “Service Excellence” by guiding members through their healthcare needs. They help members understand their benefits, resolve claim concerns, locate providers, and serve as a resource for healthcare providers. Network Health strives to deliver a better healthcare experience, ensuring members get the help they need with just one call. The company aims to provide amazing service in plain language that members will understand. The initial training period is a 6-8 week program with a work schedule of Monday - Friday from 8:00am - 4:30pm. After training, employees can select a Monday - Friday work schedule of either 8:00am to 4:30pm or 8:30am to 5:00pm. Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at home (reliable internet is required), at the office in Brookfield or Menasha, or a combination of both with a hybrid workplace model. The role is 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday.

Requirements

High school diploma or equivalent
Strong desire to help others
Excellent communication skills including the ability to clearly explain complicated subjects
Warm and pleasant demeanor over the phone. We want our members to hear your smile!
The ability to work in several computer systems and multi-screen set-up and know where to find answers

Nice To Haves

Previous experience in the insurance industry is a plus
Medical terminology background is a plus

Responsibilities

Demonstrate behaviors that align with Network Health's mission, vision, values, and organizational philosophy.
Consistently comply with all organizational policies, regulatory requirements, credentialing standards, and applicable procedures.
Respond professionally and efficiently to incoming phone calls from members, customers, providers, and brokers regarding benefits, coverage, claims, billing, authorizations, and other health plan inquiries.
Utilize active listening and effective questioning techniques to fully understand the caller's needs and achieve first-call resolution whenever possible.
Accurately document all customer interactions within the appropriate systems and complete required follow-up activities in a timely manner.
Collaborate with internal departments to resolve outstanding issues and ensure timely, accurate responses to customer inquiries.
Escalate complex or unresolved issues to a Senior Representative, Supervisor, or other appropriate resource when necessary.
Meet established departmental quality, productivity, service, and contractual performance standards.
Perform other duties and responsibilities as assigned.