Member Services Rep

Group Health Cooperative of South Central Wisconsin•Madison, WI

13d•Hybrid

About The Position

The Member Services Representative serves as the primary resource person responding to members and providers benefits, claims, referral and clinic services inquiries. This position assists members with the resolution of complaints including interviewing of complainants, investigation of the complaint and reporting the details of complaints to internal staff as appropriate. In addition, the Member Services Representative is responsible for departmental data entry and maintenance of files/records as needed. The incumbent functions under the general guidance, direction and supervision of the Member Services Manager. GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. The incumbent knows and abides by all Group Health Cooperative of South Central Wisconsin (GHC-SCW) organizational and departmental policies, sets personal standards and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner. The incumbent understands our Mission, Vision and Common Values and is committed to promote these values in behavior and attitude.

Requirements

High school education or equivalent required.
Minimum of two (2) years' experience in a responsible public contact position required.
Knowledge of or ability to learn GHC-SCW benefit plans and clinic operations required.
Knowledge of and basic ability to use various computer software including Microsoft Office and email.
Ability to use and/or learn on-line information systems such as EPIC.
Excellent verbal communication and listening skills both in-person and on the phone required.
Strong written communication skills.
Excellent customer service skills required.
Ability to be culturally sensitive and to work with a diverse patient population.
Ability to maintain telephone etiquette.
Ability to act in a professional manner when dealing with practitioner staff, personnel of other departments, fellow employees and the general public required.
Ability to maintain patient and organizational confidentiality required.
Knowledge of or ability to learn HIPAA requirements.
Ability to diplomatically handle communications in potentially stressful situations.
Excellent problem solving (investigating/explaining) skills required.
Excellent record keeping/organizational skills required.
Excellent interpersonal skills required.
Ability to work independently and manage time well required.
Ability to handle multiple projects simultaneously required.
Ability to type 35 wpm accurately required.
Ability to lift from arm to floor level and occasionally carry bulky loads ranging from 2-15 lbs required.
Ability to speak and hear on the telephone and in person required.
Near vision and mid-range vision required.
Physical agility in standing, stooping, kneeling, crouching, reaching (above shoulder, over 18" and to floor), handling and fingering required.
Applicants must reside locally and in Wisconsin to be available for on-site meetings and trainings.

Nice To Haves

Experience with an insurance, HMO, or healthcare related operation is desirable but not required.

Responsibilities

Serves as the primary resource person responding to members and providers benefits, claims, referral and clinic services inquiries.
Assists members with the resolution of complaints including interviewing of complainants, investigation of the complaint and reporting the details of complaints to internal staff as appropriate.
Responsible for departmental data entry and maintenance of files/records as needed.
Functions under the general guidance, direction and supervision of the Member Services Manager.
Knows and abides by all Group Health Cooperative of South Central Wisconsin (GHC-SCW) organizational and departmental policies.
Sets personal standards and strives for high quality work in completing assignments.
Performs job duties in a timely manner.
Represents the organization in a positive manner.
Understands our Mission, Vision and Common Values and is committed to promote these values in behavior and attitude.