Member Experience Representative

TEKsystems•Menasha, WI

1d•$18 - $18•Remote

About The Position

The Member Experience Representative’s primary focus is to answer phone, or email inquiries from providers, members, customers or brokers regarding questions of coverage, claim status, benefit interpretation, billing and/or authorizations. Proficient in one line of business, either Medicare or Group/Marketplace, translating health care related jargon into effective written or verbal communication for the end user to comprehend. Document details of the interaction within the database, including any additional action steps taken as follow up. Demonstrate commitment and behavior aligned with the philosophy, mission, values and vision. Appropriately apply all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies. Answer incoming phone calls from members, customers, providers or brokers efficiently regarding their inquiries on coverage, claim status, benefit interpretation, billing and/or authorizations. Respond to inquiries within set timeframes to adhere to department metrics and contractual standards. During telephone call, probe and ask appropriate questions to identify specifics of what caller is inquiring about to ensure first call resolution. Follow-up with customers or other departments on any outstanding issues or concerns. Escalate appropriate issues to Supervisor or appropriate individual. Support our members by answering calls and proactively work to resolve our members questions and concerns. Strive for first call resolution, working to resolve member issues at the point of contact. Use dual monitors while leveraging computer-based resources to find answers to customers questions and help simplify next steps for members. You may reach out to internal departments or external resources to help resolve a member concern. We provide a continuous learning environment where you can learn and stay current with our plans, computer systems, and insurance trends. You will have the ultimate responsibility of protecting the personal health information of our members.

Requirements

1+ year of healthcare customer service experience
Must reside in Wisconsin

Nice To Haves

Proficient in one line of business, either Medicare or Group/Marketplace

Responsibilities

Answer phone, or email inquiries from providers, members, customers or brokers regarding questions of coverage, claim status, benefit interpretation, billing and/or authorizations.
Translate health care related jargon into effective written or verbal communication for the end user to comprehend.
Document details of the interaction within the database, including any additional action steps taken as follow up.
Demonstrate commitment and behavior aligned with the philosophy, mission, values and vision.
Appropriately apply all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies.
Answer incoming phone calls from members, customers, providers or brokers efficiently regarding their inquiries on coverage, claim status, benefit interpretation, billing and/or authorizations.
Respond to inquiries within set timeframes to adhere to department metrics and contractual standards.
Probe and ask appropriate questions to identify specifics of what caller is inquiring about to ensure first call resolution.
Follow-up with customers or other departments on any outstanding issues or concerns.
Escalate appropriate issues to Supervisor or appropriate individual.
Support our members by answering calls and proactively work to resolve our members questions and concerns.
Strive for first call resolution, working to resolve member issues at the point of contact.
Use dual monitors while leveraging computer-based resources to find answers to customers questions and help simplify next steps for members.
Reach out to internal departments or external resources to help resolve a member concern.
Protect the personal health information of our members.