Customer Service Representative II

Employer Health Care Alliance Coop., Inc; Fitchburg (WI); On-site; USD 29,000 - 32,000; Full time

Job summary

The Alliance is seeking a Customer Services Representative II in Fitchburg, WI to independently handle inquiries and issues related to health insurance networks, claims, repricing, and eligibility. You will coordinate with internal teams and external partners to deliver timely resolutions, educate consumers, and maintain service levels.

Required is a high school diploma and proven customer service experience, with strong communication, problem-solving, and research abilities.

Qualifications

• Demonstrated customer service experience with the ability to independently manage a broad range of customer inquiries and concerns.
• Working knowledge of health care networks, claims, eligibility, repricing, and related Customer Services processes.
• Ability to research and resolve moderately complex customer issues by gathering information from multiple systems, resources, or departments.
• Strong judgment and problem-solving skills, including the ability to determine appropriate next steps and recognize when escalation is necessary.
• Ability to explain complex or unfamiliar information to consumers in a clear, understandable, and supportive manner.

Responsibilities

• Maintains a positive and approachable demeanor in all customer interactions, showing a genuine interest in helping consumers and improving their experience.
• Helps member employees navigate their health insurance network providers.
• Independently provides customer service via telephone and email, answering questions and resolving issues related to electronic claims filing, repricing, network-related inquiries, and other established Customer Services processes.
• Refers consumers to the appropriate third-party administrator (TPA) or other resource for claims status, eligibility, or matters requiring assistance outside The Alliance’s scope.
• Provides education and resources to empower consumers to make informed health care decisions.
• Responds to written correspondence within established timeframes.

Skills

Customer service

Healthcare networks

Communication

Research

Problem solving

Education

High school diploma

Tools

CRM systems

Job description

• Location 5520 Nobel Drive,Suite 125,Fitchburg, WI, 53711,United States
• Base Pay $21.00 - $22.50 / Hour
• Job Category Customer Service, Health Care Provider, Administrative
• Industry Insurance, Hospitals and Health Care, Health and Human Services
• Employee Type Non-Exempt
• Required Degree High school
• Manage Others No

Contact information

• Name Employee Experience at The Alliance
• Phone [phone]
• Email [e-mail]

Description

How You Will Contribute

Customer Support & Advocacy

• Maintains a positive and approachable demeanor in all customer interactions, showing a genuine interest in helping consumers and improving their experience.
• Helps member employees navigate their health insurance network providers.
• Independently provides customer service via telephone and email, answering questions and resolving issues related to electronic claims filing, repricing, network-related inquiries, and other established Customer Services processes.
• Refers consumers to the appropriate third-party administrator (TPA) or other resource for claims status, eligibility, or matters requiring assistance outside The Alliance’s scope.
• Provides education and resources to empower consumers to make informed health care decisions.
• Responds to written correspondence within established timeframes.

I ssue Resolution & Collaboration

• Researches customer questions and concerns using available systems and resources and identifies appropriate solutions or next steps.
• Independently resolves standard customer issues and determines when additional expertise, referral, or escalation is appropriate.
• Takes ownership of customer inquiries and supports timely follow-through and resolution.
• Accurately documents customer interactions, research, actions taken, and relevant information to support continuity of service.
• Collaborates with Customer Services staff, other departments, and appropriate external partners to resolve customer issues.

Customer Insights & Continuous Improvement

• Proactively collects and shares consumer feedback to identify recurring concerns and opportunities to improve the customer experience.
• Recognizes patterns in customer inquiries and communicates observations to the Director or other appropriate Alliance staff.
• Contributes ideas and feedback that support improvements to Customer Services processes, resources, and service delivery.
• Maintains proficient knowledge of The Alliance’s networks, services, systems, terminology, and Customer Services processes.
• Assists with data entry and other departmental responsibilities as needed.

Requirements

Your Qualifications

• High school diploma or equivalent.
• Demonstrated customer service experience with the ability to independently manage a broad range of customer inquiries and concerns.
• Working knowledge of health care networks, claims, eligibility, repricing, and related Customer Services processes.
• Ability to research and resolve moderately complex customer issues by gathering information from multiple systems, resources, or departments.
• Strong judgment and problem-solving skills, including the ability to determine appropriate next steps and recognize when escalation is necessary.
• Ability to explain complex or unfamiliar information to consumers in a clear, understandable, and supportive manner.
• Strong verbal and written communication skills with demonstrated accuracy and professionalism.
• Ability to manage challenging customer interactions while maintaining composure, empathy, and a high standard of service.
• Ability to identify patterns or recurring customer issues and communicate observations that may improve processes or the customer experience.
• Ability to work effectively across departments to facilitate issue resolution.
• Demonstrated reliability in managing workload, documentation, follow-up, and established service expectations with limited guidance.
• Ability to meet and maintain established departmental expectations for productivity, accuracy, quality, and timeliness.

Preferred Qualifications

• Two or more years of customer service, advocacy, health care, health insurance, or related experience.
• Experience with health care networks, claims processing, TPAs, benefits administration, or related health insurance functions.
• Proficiency with CRM systems and other Customer Services technology.

Physical Requirements

• Regularly performs computer-based work and remains in a stationary position for extended periods.
• Frequently uses a computer, telephone, and other standard office equipment.
• Communicates with customers and colleagues by telephone, email, virtual platforms, and in person.
• Occasionally moves throughout the work environment and handles office materials or equipment weighing up to 10 pounds.
• Performs the essential functions of the position with or without reasonable accommodation.

Summary

What to Know about the Job

The Customer Services Representative II supports The Alliance’s mission to move health care forward by advocating for consumers and ensuring they have the knowledge and resources needed to make informed health care decisions.

As a proficient member of the Customer Services team, this role independently responds to inquiries and resolves issues related to health insurance networks, claims, repricing, and eligibility. The Customer Services Representative II researches customer concerns, provides education and resources, coordinates with appropriate internal and external partners, and identifies opportunities to enhance the customer experience and service delivery.

Who We Are

At The Alliance, our mission is helping employers self-fund smart. We serve as the voice for self-funded employers who want more control over their healthcare costs and who believe that affordable, high-quality care should be accessible to everyone.

Why Work at The Alliance?

Along with the satisfaction you’ll receive from working with a mission-driven organization, you’ll join a humble, lively, and hard-working group of people. The Alliance is home to a highly collaborative, creative, and dedicated bunch; you’ll feel our warm friendliness, be fueled by our inspiring passion, and find support from us when you need it, too.